| Merging Rivers Llc | |
|
2420 Cleveland Ave N Roseville MN 55113-2727 | |
| (952) 900-2749 | |
| (952) 333-7493 |
| Full Name | Merging Rivers Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2420 Cleveland Ave N, Roseville, Minnesota |
| Authorized Official Name and Position | Alexander Sullivan (OWNER) |
| Authorized Official Contact | 9529002749 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Merging Rivers Llc 4905 31st Ave S Minneapolis MN 55417-1403 Ph: (952) 900-2749 | Merging Rivers Llc 2420 Cleveland Ave N Roseville MN 55113-2727 Ph: (952) 900-2749 |
| NPI Number | 1649091588 |
|---|---|
| Provider Enumeration Date | 10/23/2024 |
| Last Update Date | 01/30/2025 |
| Certification Date | 01/30/2025 |
| Medicare PECOS PAC ID | 9739615949 |
|---|---|
| Medicare Enrollment ID | O20241211003533 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649091588 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Alexander Blake Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922622042 PECOS PAC ID: 8820407190 Enrollment ID: I20220809003109 |
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