MEDICARE: AFRICAN AMERICAN FAMILY SERVICES

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	8059762CDT	MN
2	251S00000X	Community/Behavioral Health Agency	80113422CDT	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	707055100	OTHER	MN	MN DHS PROVIDER IHENNEPIN
2	010757300	OTHER	MN	MNDHS PROVIDER NUMBER

General Provider Information

NPI Number	:	1942471370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFRICAN AMERICAN FAMILY SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 8900
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-0900
Country	:	US
Telephone Number	:	612-871-7878
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 SELBY AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-6535
Country	:	US
Telephone Number	:	612-871-7878
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	MR. JONATHAN G LOFGREN
Credential	:	LADC
Telephone Number	:	612-238-2302

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

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Directions to “AFRICAN AMERICAN FAMILY SERVICES ” Practice Location

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