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5384 5th St Ne Fridley MN 55421-1108 | |
| (763) 572-0009 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5384 5th St Ne, Fridley, Minnesota |
| Authorized Official Name and Position | Deena G. Ombres (ASSOC. GEN. COUNSEL/PRIVACY OFFICER) |
| Authorized Official Contact | 5023942100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9901 Linn Station Rd Louisville KY 40223-3808 Ph: (502) 394-2100 | 5384 5th St Ne Fridley MN 55421-1108 Ph: (763) 572-0009 |
| NPI Number | 1922444157 |
|---|---|
| Provider Enumeration Date | 05/15/2013 |
| Last Update Date | 05/15/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922444157 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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