Provider Demographics
NPI:1366220493
Name:SOLACE HEALING LLC
Entity type:Organization
Organization Name:SOLACE HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAID
Authorized Official - Middle Name:BASHIR
Authorized Official - Last Name:A
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-666-8152
Mailing Address - Street 1:5401 94TH AVE N UNIT 345
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-5502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5401 94TH AVE N UNIT 345
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-5502
Practice Address - Country:US
Practice Address - Phone:612-666-8152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management