Creative Dream Early Intervention LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

CREATIVE DREAM EARLY INTERVENTION LLC

Practice address

1250 Moore Lake Dr E Ste 205
Fridley, MN 55432-5176

Phone

(763) 291-9931

NPI assigned

Oct 31, 2024

Last updated

Oct 31, 2024By 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

Isra AhmedNPI 1568268274

Title

Manager

Phone

(763) 291-9931

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, and the practitioner matching its NPPES authorized official.

• Isra Ahmed

  • Behavior Technician
  • Fridley, MN
  • NPI 1568268274
  NPD Authorized official

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

{
    "created_epoch": "1730332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1336961143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 MOORE LAKE DR E STE 205",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 MOORE LAKE DR E STE 205",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325176",
            "telephone_number": "763-291-9931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE DREAM EARLY INTERVENTION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-31",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "ISRA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "763-291-9931"
    },
    "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 Fridley, MN
• Providers in Fridley, 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 Oct 31, 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.