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2311 Woodbridge St Roseville MN 55113-4710 | |
| (651) 773-0832 | |
| (651) 773-9115 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2311 Woodbridge St, Roseville, Minnesota |
| Authorized Official Name and Position | Patrick John Chunn (CFO) |
| Authorized Official Contact | 4073517080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2500 Maitland Center Parkway Suite 250 Maitland FL 32751 Ph: (407) 351-7080 | 2311 Woodbridge St Roseville MN 55113-4710 Ph: (651) 773-0832 |
| NPI Number | 1215143441 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 11/22/2021 |
| Certification Date | 11/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215143441 | NPI | - | NPPES |
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