Healthcare Provider Details

I. General information

NPI: 1356919328
Provider Name (Legal Business Name): EMERGE SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 HAMLINE AVE N STE 217
SAINT PAUL MN
55113-5004
US

IV. Provider business mailing address

2233 HAMLINE AVE N STE 217
SAINT PAUL MN
55113-5004
US

V. Phone/Fax

Practice location:
  • Phone: 651-500-1449
  • Fax:
Mailing address:
  • Phone: 651-500-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RABIIC OMAR
Title or Position: OWNER & CEO
Credential:
Phone: 651-703-8410