Impact Autism SC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

IMPACT AUTISM SC

Practice address

6160 Summit Dr N Ste 200
Brooklyn Center, MN 55430-2181

Phone

(619) 576-6887

NPI assigned

Nov 5, 2024

Organization subpart

No

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

Authorized official

Name

Fadumo Adem

Title

Operational Manger

Phone

(619) 576-6887

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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

• Faduma Adem

  • Behavior Technician
  • Brooklyn Center, MN
  • NPI 1396628483
  NPD
• Ibrahim Abdiqani Mohamed

  • Behavior Technician
  • Brooklyn Center, MN
  • NPI 1639060643
  NPD
• Umalkayr Nour

  • Behavior Technician
  • Brooklyn Center, MN
  • NPI 1962388108
  NPD

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

{
    "created_epoch": "1730764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1548083769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6160 SUMMIT DR N",
            "address_2": "SUITE 200 OFFICE #219",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "55430",
            "telephone_number": "619-576-6887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6160 SUMMIT DR N STE 200",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302181",
            "telephone_number": "619-576-6887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT AUTISM SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-05",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A",
        "authorized_official_last_name": "ADEM",
        "authorized_official_first_name": "FADUMO",
        "authorized_official_title_or_position": "OPERATIONAL MANGER",
        "authorized_official_telephone_number": "619-576-6887"
    },
    "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 Brooklyn Center, MN
• Providers in Brooklyn Center, 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 Nov 5, 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.