Healthcare Provider Details

I. General information

NPI: 1710899786
Provider Name (Legal Business Name): BOYS & GIRLS CLUBS OF THE TWIN CITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 IRVING AVE N
MINNEAPOLIS MN
55411-2065
US

IV. Provider business mailing address

690 JACKSON ST
SAINT PAUL MN
55130-4345
US

V. Phone/Fax

Practice location:
  • Phone: 612-522-3636
  • Fax:
Mailing address:
  • Phone: 651-726-2582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: TERRYL BRUMM
Title or Position: PRESIDENT & CEO
Credential:
Phone: 612-715-2120