| Ally Supportive Services, Llc | |
|
245 Marie Ave E Ste 107 West St Paul MN 55118-4280 | |
| (651) 302-4471 | |
| Not Available |
| Full Name | Ally Supportive Services, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 245 Marie Ave E Ste 107, West St Paul, Minnesota |
| Authorized Official Name and Position | Nathan Tonnancour (CHIEF MANAGER) |
| Authorized Official Contact | 6513024471 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ally Supportive Services, Llc Po Box 544 South St Paul MN 55075-0544 Ph: (651) 302-4471 | Ally Supportive Services, Llc 245 Marie Ave E Ste 107 West St Paul MN 55118-4280 Ph: (651) 302-4471 |
| NPI Number | 1407449846 |
|---|---|
| Provider Enumeration Date | 02/17/2021 |
| Last Update Date | 02/17/2021 |
| Certification Date | 02/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407449846 | NPI | - | NPPES |
| A720082300 | Other | MN | STATE OF MINNESOTA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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