Healthcare Provider Details

I. General information

NPI: 1679817936
Provider Name (Legal Business Name): THE JONAS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 12TH ST E
GLENCOE MN
55336-2315
US

IV. Provider business mailing address

925 12TH ST E
GLENCOE MN
55336-2315
US

V. Phone/Fax

Practice location:
  • Phone: 320-864-6139
  • Fax:
Mailing address:
  • Phone: 320-864-6139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number02425
License Number StateMN

VIII. Authorized Official

Name: MR. JAMES JONAS
Title or Position: DIRECTOR
Credential: LICSW
Phone: 952-361-9700