Healthcare Provider Details

I. General information

NPI: 1154559276
Provider Name (Legal Business Name): MAI'S ADULT FOSTER CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 DULUTH ST
SAINT PAUL MN
55106-1117
US

IV. Provider business mailing address

1657 DULUTH ST
SAINT PAUL MN
55106-1117
US

V. Phone/Fax

Practice location:
  • Phone: 651-235-5287
  • Fax: 651-771-7974
Mailing address:
  • Phone: 651-235-5287
  • Fax: 651-771-7974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number1042011-2-AFC
License Number StateMN

VIII. Authorized Official

Name: MAI CHA MOUA
Title or Position: OWNER
Credential:
Phone: 651-235-5287