Abijah'S on the Backside

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

ABIJAH'S ON THE BACKSIDE

Practice address

1100 Canterbury Rd S
Shakopee, MN 55379-1867

Phone

(715) 379-1370

NPI assigned

Mar 15, 2024

Organization subpart

No

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

Authorized official

Name

Sally Mixon, MANPI 1356665319

Title

Founder / Ceo

Phone

(715) 379-1370

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sally Jane Mixon

  • Counselor
  • McAlester, OK
  • NPI 1356665319
  NPD Authorized official

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

{
    "created_epoch": "1710460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710460800000",
    "number": "1245099837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 583",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553790583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 CANTERBURY RD S",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553791867",
            "telephone_number": "715-379-1370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABIJAH'S ON THE BACKSIDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-15",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A",
        "authorized_official_last_name": "MIXON",
        "authorized_official_first_name": "SALLY",
        "authorized_official_title_or_position": "FOUNDER / CEO",
        "authorized_official_telephone_number": "715-379-1370",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iman Abdalla
• Bahja Abdi
• Mohamud Abdi
• Khadija Abdirahman Abdilahi
• Ifrah Mohamed Abdullahi
• Eseoghene Abokede, M.D
• Kelsey Marie Danzeisen Abraham, OT
• Aaisha Abukar
• Acts Therapy LLC
• Abdinasir Adam

• Community/Behavioral Health Agency in Shakopee, MN
• Providers in Shakopee, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; 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.