NPIMap

Organization Active NPI

Prime Growth Behavior Services Inc.

  • Community/Behavioral Health Agency
  • Minneapolis, MN
National Provider Identifier
1073262671
Registry record updated May 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PRIME GROWTH BEHAVIOR SERVICES INC.
Practice address
3401 Hiawatha Ave
Minneapolis, MN 55406-2525
Phone
(612) 353-4133
Fax
(612) 886-2080
NPI assigned
Mar 21, 2022
Last updated
May 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2023

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

Authorized official

Name
Idil A GuledNPI 1134855059
Title
Executive Director
Phone
(612) 353-4133

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
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

3401 Hiawatha Ave
Minneapolis, MN 55406-2525

Mailing address

3401 Hiawatha Ave
Minneapolis, MN 55406-2525
Phone (612) 353-4133

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1647820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1073262671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 HIAWATHA AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554062525",
            "telephone_number": "612-353-4133",
            "fax_number": "612-886-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 HIAWATHA AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554062525",
            "telephone_number": "612-353-4133",
            "fax_number": "612-886-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME GROWTH BEHAVIOR SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-21",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "GULED",
        "authorized_official_first_name": "IDIL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-353-4133"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; 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.