| Janet's Residence | |
|
950 9th Ave St Paul Park MN 55071-1436 | |
| (651) 734-9633 | |
| (651) 734-9533 |
| Full Name | Janet's Residence |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 950 9th Ave, St Paul Park, Minnesota |
| Authorized Official Name and Position | Robert Leonard Haven (OWNER/PRESIDENT) |
| Authorized Official Contact | 6517349633 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Janet's Residence 950 9th Ave St Paul Park MN 55071-1436 Ph: (651) 734-9633 | Janet's Residence 950 9th Ave St Paul Park MN 55071-1436 Ph: (651) 734-9633 |
| NPI Number | 1801959499 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 03/02/2021 |
| Certification Date | 03/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801959499 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1011741-1-CDT (Minnesota) | Primary |
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