Provider Demographics
NPI:1871318543
Name:ARCANE AUTISM CENTER LLC
Entity type:Organization
Organization Name:ARCANE AUTISM CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMSA
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-517-4163
Mailing Address - Street 1:8011 34TH AVE S STE 239B
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1637
Mailing Address - Country:US
Mailing Address - Phone:612-517-4163
Mailing Address - Fax:
Practice Address - Street 1:8011 34TH AVE S STE 239B
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1637
Practice Address - Country:US
Practice Address - Phone:612-517-4163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center