| Shalom Mental Health Services | |
|
3751 Ridge Ave Anoka MN 55303-1489 | |
| (515) 918-3955 | |
| Not Available |
| Full Name | Shalom Mental Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 3751 Ridge Ave, Anoka, Minnesota |
| Authorized Official Name and Position | Azie Judith Khan (OWNER/CEO) |
| Authorized Official Contact | 5159183955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shalom Mental Health Services 7211 208th Cir N Forest Lake MN 55025-2903 Ph: (515) 918-3955 | Shalom Mental Health Services 3751 Ridge Ave Anoka MN 55303-1489 Ph: (515) 918-3955 |
| NPI Number | 1154179778 |
|---|---|
| Provider Enumeration Date | 05/08/2024 |
| Last Update Date | 05/08/2024 |
| Certification Date | 05/08/2024 |
| Medicare PECOS PAC ID | 5698211084 |
|---|---|
| Medicare Enrollment ID | O20240722002551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154179778 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Azie Judith Khan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265012629 PECOS PAC ID: 1557769858 Enrollment ID: I20211015002568 |
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