MEDICARE: PARTNERS IN COMMUNITY SUPPORTS

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	251E00000X	Home Health Agency	4927110	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083871263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTNERS IN COMMUNITY SUPPORTS

Provider Business Mailing Address
First Line	:	1605 EUSTIS ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-1219
Country	:	US
Telephone Number	:	651-967-5060
Fax Number	:	651-967-5061

Provider Business Practice Location Address
First Line	:	1605 EUSTIS ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-1219
Country	:	US
Telephone Number	:	651-967-5060
Fax Number	:	651-967-5061

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	BRIGID PETERSON
Credential	:
Telephone Number	:	651-310-9451

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	03/13/2017

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Directions to “PARTNERS IN COMMUNITY SUPPORTS ” Practice Location

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