Healthcare Provider Details

I. General information

NPI: 1114948833
Provider Name (Legal Business Name): HEALTHEAST ST. JOSEPH'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 10TH STREET WEST
SAINT PAUL MN
55102-1004
US

IV. Provider business mailing address

45 10TH STREET WEST
SAINT PAUL MN
55102-1004
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-3312
  • Fax: 651-232-3494
Mailing address:
  • Phone: 651-232-3312
  • Fax: 651-232-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number330330
License Number StateMN

VIII. Authorized Official

Name: DOUG DAVENPORT
Title or Position: CFO
Credential:
Phone: 651-232-2250