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2300 15th Ave S Minneapolis MN 55404-3960 | |
| (612) 728-2000 | |
| (612) 728-2039 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2300 15th Ave S, Minneapolis, Minnesota |
| Authorized Official Name and Position | Lori Magnuson (FINANCE DIRECTOR) |
| Authorized Official Contact | 6127282006 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2300 15th Ave S Minneapolis MN 55404-3960 Ph: (612) 728-2000 | 2300 15th Ave S Minneapolis MN 55404-3960 Ph: (612) 728-2000 |
| NPI Number | 1992887863 |
|---|---|
| Provider Enumeration Date | 10/20/2006 |
| Last Update Date | 04/08/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992887863 | NPI | - | NPPES |
| 8441666 | Other | MN | MEDICA |
| 0782704 | Other | MN | HENNEPIN COUNTY CHEMICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 801557-1-CDT (Minnesota) | Primary |
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