MEDICARE: THE AFRICAN AMERICAN ADOPTION AGENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	830556	MN
2	251B00000X	Case Management Agency	830556	MN

General Provider Information

NPI Number	:	1033367057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE AFRICAN AMERICAN ADOPTION AGENCY

Provider Business Mailing Address
First Line	:	2356 UNIVERSITY AVE W
Second Line	:	SUITE 220
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1853
Country	:	US
Telephone Number	:	651-659-0460
Fax Number	:

Provider Business Practice Location Address
First Line	:	2356 UNIVERSITY AVE W
Second Line	:	SUITE 220
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1853
Country	:	US
Telephone Number	:	651-659-0460
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARQUITA STEPHENS
Credential	:
Telephone Number	:	651-659-0460

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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Directions to “THE AFRICAN AMERICAN ADOPTION AGENCY ” Practice Location

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