Organization Active NPI

ABA Community Care LLC

  • Clinic/Center
  • Saint Cloud, MN
National Provider Identifier
1063221000
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ABA COMMUNITY CARE LLC
Practice address
22 Wilson Ave NE Ste 101
Saint Cloud, MN 56304-0406
Phone
(320) 420-3168
Fax
(320) 968-1251
NPI assigned
Jan 3, 2025
Last updated
Jan 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Abdirahman Mohamud MohamedNPI 1154010395
Title
Owner
Phone
(320) 420-3168

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

22 Wilson Ave NE Ste 101
Saint Cloud, MN 56304-0406

Mailing address

22 Wilson Ave NE Ste 101
Saint Cloud, MN 56304-0406
Phone (320) 420-3168

National Provider Directory

National Provider Directory

Locations

22 Wilson Ave NE
Ste 101
Saint Cloud, MN 56304
Phone (320) 420-3168

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1735862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735862400000",
    "number": "1063221000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 WILSON AVE NE STE 101",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563040406",
            "telephone_number": "320-420-3168",
            "fax_number": "320-968-1251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 WILSON AVE NE STE 101",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563040406",
            "telephone_number": "320-420-3168",
            "fax_number": "320-968-1251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABA COMMUNITY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-03",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "ABDIRAHMAN",
        "authorized_official_middle_name": "MOHAMUD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-420-3168"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.