Healthcare Provider Details

I. General information

NPI: 1952477085
Provider Name (Legal Business Name): COMUNIDADES LATINAS UNIDAS EN SERVICIO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 7TH ST E
SAINT PAUL MN
55106-5014
US

IV. Provider business mailing address

797 7TH ST E
SAINT PAUL MN
55106-5014
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-4200
  • Fax: 651-292-0347
Mailing address:
  • Phone: 651-379-4200
  • Fax: 651-292-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA PLESKOVITCH
Title or Position: ACCOUNTANT II
Credential:
Phone: 651-379-4200