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General NPI Number Information
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NPI Number | 1093882656
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Entity Type | Organization
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Legal Business Name | THE SALVATION ARMY
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 12/02/2019
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Provider Practice Location Address
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Address Line | 120 N BROADWAY STE B
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City | ROCHESTER
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State | MN
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Zip | 55906-3728
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Country | US
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Telephone | 507-529-4100
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Fax | 507-529-4101
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Provider Business Mailing Address
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Address Line | 20 1ST AVE NE
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City | ROCHESTER
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State | MN
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Zip | 55906-3706
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Country | US
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Telephone | 507-529-4100
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Fax | 507-529-4101
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Authorized Official
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Title or Position | GOVERNMENT GRANTWRITER
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Name | ALLISON UTHKE-SCALETTA
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Credential | DELEGATED OFFICIAL
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Telephone | 651-746-3543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 867910000
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License Number State | MN
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