| Synergen Behavioral Health, P.a. | |
|
2785 White Bear Ave N Ste 105 Maplewood MN 55109-1320 | |
| (651) 433-7207 | |
| (651) 410-1502 |
| Full Name | Synergen Behavioral Health, P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2785 White Bear Ave N Ste 105, Maplewood, Minnesota |
| Authorized Official Name and Position | Ronald Jerome Hardrict (PRESIDENT/CEO) |
| Authorized Official Contact | 6514337207 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Synergen Behavioral Health, P.a. 2785 White Bear Ave N Ste 105 Maplewood MN 55109-1320 Ph: (651) 433-7207 | Synergen Behavioral Health, P.a. 2785 White Bear Ave N Ste 105 Maplewood MN 55109-1320 Ph: (651) 433-7207 |
| NPI Number | 1740829837 |
|---|---|
| Provider Enumeration Date | 01/06/2020 |
| Last Update Date | 01/16/2025 |
| Certification Date | 01/16/2025 |
| Medicare PECOS PAC ID | 3678998796 |
|---|---|
| Medicare Enrollment ID | O20200806002886 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740829837 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Ronald J Hardrict |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689719742 PECOS PAC ID: 6901792803 Enrollment ID: I20040226000819 |
| Provider Name | Jonathan C Hoistad |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588779292 PECOS PAC ID: 2961433982 Enrollment ID: I20050908000663 |
| Provider Name | Joseph A Akoh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730637588 PECOS PAC ID: 2163700394 Enrollment ID: I20161024000506 |
| Provider Name | Caroline W Kuria |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801346093 PECOS PAC ID: 6406130426 Enrollment ID: I20170310001005 |
| Provider Name | Mercy Kilikpo Miantona |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952838997 PECOS PAC ID: 6103197967 Enrollment ID: I20170812000396 |
| Provider Name | Lilian Omodi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124799499 PECOS PAC ID: 1759750821 Enrollment ID: I20221212002479 |
| Provider Name | Nicole Belleville |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235899162 PECOS PAC ID: 6103279997 Enrollment ID: I20240129001127 |
| Provider Name | Eve Marie Kaldahl |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548548274 PECOS PAC ID: 8628421195 Enrollment ID: I20240131003508 |
| Provider Name | Roberta Sorenson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548624026 PECOS PAC ID: 7719338110 Enrollment ID: I20240209000779 |
| Provider Name | Julie Blaske |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124486246 PECOS PAC ID: 8022453331 Enrollment ID: I20240227000462 |
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