Intergalactic Therapy Centre LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

INTERGALACTIC THERAPY CENTRE LLC

Practice address

860 Blue Gentian Rd Ste 200
Eagan, MN 55121-1567

Phone

(612) 458-8723

Fax

(612) 455-2185

NPI assigned

Aug 19, 2020

Last updated

Sep 18, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Garad Hagi Mohamed Sr.NPI 1619589728

Title

Owner

Phone

(612) 458-8723

Specialties & licenses 1

Addresses

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.

• Garad Hagi Mohamed Sr.

  • Behavior Technician
  • Eagan, MN
  • NPI 1619589728
  NPD Authorized official

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600387200000",
    "number": "1255943361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 BLUE GENTIAN RD STE 200",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551211567",
            "telephone_number": "612-458-8723",
            "fax_number": "612-455-2185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 BLUE GENTIAN RD STE 200",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551211567",
            "telephone_number": "612-458-8723",
            "fax_number": "612-455-2185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERGALACTIC THERAPY CENTRE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "GARAD",
        "authorized_official_middle_name": "HAGI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-458-8723",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Early Intervention Provider Agency in Eagan, MN
• Providers in Eagan, MN by specialty
• Early Intervention Provider Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; 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.