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Contact Information

ABIJAH'S ON THE BACKSIDE
1100 CANTERBURY RD S
SHAKOPEE, MN55379-1867
 Phone: 715-379-1370
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Behavioral Health

251S00000X
Indicates primary specialty

NPI Profile & details for ABIJAH'S ON THE BACKSIDE

NPI # 1245099837
LBN Legal business name ABIJAH'S ON THE BACKSIDE
Authorized official SALLY MIXON - (FOUNDER / CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 03/15/2024
Last updated 03/15/2024 - About 2 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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