Healthcare Provider Details

I. General information

NPI: 1033367057
Provider Name (Legal Business Name): THE AFRICAN AMERICAN ADOPTION AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2356 UNIVERSITY AVE W SUITE 220
SAINT PAUL MN
55114-1853
US

IV. Provider business mailing address

2356 UNIVERSITY AVE W SUITE 220
SAINT PAUL MN
55114-1853
US

V. Phone/Fax

Practice location:
  • Phone: 651-659-0460
  • Fax:
Mailing address:
  • Phone: 651-659-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number830556
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number830556
License Number StateMN

VIII. Authorized Official

Name: MARQUITA STEPHENS
Title or Position: PRESIDENT
Credential:
Phone: 651-659-0460