MEDICARE: ISAIAH SIXTY-ONE MINISTRIES

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

General Provider Information

NPI Number	:	1932421278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISAIAH SIXTY-ONE MINISTRIES

Provider Business Mailing Address
First Line	:	5637 BROOKLYN BLVD
Second Line	:	SUITE 200
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3061
Country	:	US
Telephone Number	:	763-234-3728
Fax Number	:	763-533-0406

Provider Business Practice Location Address
First Line	:	5637 BROOKLYN BLVD
Second Line	:	SUITE 200
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3061
Country	:	US
Telephone Number	:	763-234-3728
Fax Number	:	763-533-0406

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. JOSHUA ADAM RAMPI
Credential	:	LMFT
Telephone Number	:	763-234-3728

Provider Enumeration Date	:	02/26/2010
Last Update Date	:	02/26/2010

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