North Star Residential Services LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

NORTH STAR RESIDENTIAL SERVICES LLC

Practice address

5701 Shingle Creek Pkwy Ste 210F
Brooklyn Center, MN 55430-2330

Phone

(612) 978-1992

NPI assigned

Apr 22, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Ahmed Abdulkadir

Title

Executive Director

Phone

(612) 978-1992

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1650585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1801530233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 SHINGLE CREEK PKWY STE 210F",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302330",
            "telephone_number": "612-978-1992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 SHINGLE CREEK PKWY STE 210F",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302330",
            "telephone_number": "612-978-1992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH STAR RESIDENTIAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-22",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "ABDULKADIR",
        "authorized_official_first_name": "AHMED",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-978-1992",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; 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.