Healthcare Provider Details

I. General information

NPI: 1548340813
Provider Name (Legal Business Name): CEDAR RIVERSIDE PEOPLE'S CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 20TH AVENUE SOUTH
MINNEAPOLIS MN
55454-4400
US

IV. Provider business mailing address

425 20TH AVENUE SOUTH
MINNEAPOLIS MN
55454-4400
US

V. Phone/Fax

Practice location:
  • Phone: 612-332-4973
  • Fax: 612-238-3534
Mailing address:
  • Phone: 612-332-4973
  • Fax: 612-238-3534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number6075748
License Number StateMN

VIII. Authorized Official

Name: ANN CHRISTINE ROGERS
Title or Position: CEO
Credential:
Phone: 612-332-4973