Healthcare Provider Details

I. General information

NPI: 1619233434
Provider Name (Legal Business Name): JEWISH FAMILY AND CHILDREN'S SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 GOLDEN VALLEY RD
GOLDEN VALLEY MN
55422-4463
US

IV. Provider business mailing address

5905 GOLDEN VALLEY RD
GOLDEN VALLEY MN
55422-4463
US

V. Phone/Fax

Practice location:
  • Phone: 952-546-0616
  • Fax: 952-593-1778
Mailing address:
  • Phone: 952-546-0616
  • Fax: 952-593-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMN

VIII. Authorized Official

Name: DANIEL BELICH
Title or Position: CFO
Credential:
Phone: 952-542-0616