Healthcare Provider Details

I. General information

NPI: 1043919780
Provider Name (Legal Business Name): AXIS ALTERNATIVES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 RICE ST STE 112
ROSEVILLE MN
55113-3745
US

IV. Provider business mailing address

2345 RICE ST STE 112
ROSEVILLE MN
55113-3745
US

V. Phone/Fax

Practice location:
  • Phone: 651-357-1100
  • Fax: 651-357-1100
Mailing address:
  • Phone: 651-357-1100
  • Fax: 651-774-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DENISE SCHOLLJEGERDES
Title or Position: CFO
Credential:
Phone: 651-357-1100