Healthcare Provider Details

I. General information

NPI: 1790851863
Provider Name (Legal Business Name): AMHERST H. WILDER FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 7TH ST E
SAINT PAUL MN
55106-5025
US

IV. Provider business mailing address

650 MARSHALL AVE
SAINT PAUL MN
55104-6644
US

V. Phone/Fax

Practice location:
  • Phone: 651-280-2500
  • Fax:
Mailing address:
  • Phone: 651-280-2500
  • Fax: 651-224-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LENI G WILCOX
Title or Position: DIVISION DIRECTOR, CSE
Credential:
Phone: 651-280-2500