| Family Revelations Inc. | |
|
1705 Cope Ave E Ste I Maplewood MN 55109-2639 | |
| (651) 319-6484 | |
| (651) 925-0442 |
| Full Name | Family Revelations Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1705 Cope Ave E Ste I, Maplewood, Minnesota |
| Authorized Official Name and Position | Bernie Jerome Menge (OWNER / PARTNER) |
| Authorized Official Contact | 6513196484 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Revelations Inc. 1705 Cope Ave E Ste I Maplewood MN 55109-2639 Ph: (651) 319-6484 | Family Revelations Inc. 1705 Cope Ave E Ste I Maplewood MN 55109-2639 Ph: (651) 319-6484 |
| NPI Number | 1790212926 |
|---|---|
| Provider Enumeration Date | 05/18/2017 |
| Last Update Date | 06/11/2019 |
| Medicare PECOS PAC ID | 2860831229 |
|---|---|
| Medicare Enrollment ID | O20240417003768 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790212926 | NPI | - | NPPES |
| 1134490469 | Medicaid | MN |
| Provider Name | Bernie Menge |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1134490469 PECOS PAC ID: 1759720113 Enrollment ID: I20240417003934 |
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