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9220 Bass Lake Rd Ste 255 New Hope MN 55428-3019 | |
| (952) 945-4052 | |
| (888) 965-5130 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9220 Bass Lake Rd Ste 255, New Hope, Minnesota |
| Authorized Official Name and Position | Sarah Fjelstul (VP FINANCE) |
| Authorized Official Contact | 7632254052 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7625 Metro Blvd Ste 200 Edina MN 55439-3057 Ph: (952) 945-4092 | 9220 Bass Lake Rd Ste 255 New Hope MN 55428-3019 Ph: (952) 945-4052 |
| NPI Number | 1548436090 |
|---|---|
| Provider Enumeration Date | 05/05/2008 |
| Last Update Date | 11/13/2020 |
| Certification Date | 10/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548436090 | NPI | - | NPPES |
| 098222900 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 8105041MHC (Minnesota) | Primary |
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