Healthcare Provider Details

I. General information

NPI: 1225219983
Provider Name (Legal Business Name): COMUNIDADES LATINAS UNIDAS EN SERVICIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 EAST 7TH STREET
SAINT PAUL MN
55106
US

IV. Provider business mailing address

797 EAST 7TH STREET
SAINT PAUL MN
55106
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1021511-5-ADC
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number922829
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. AMANDA PLESKOVITCH
Title or Position: ACCOUNTANT
Credential:
Phone: 612-746-3500