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General NPI Number Information
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NPI Number | 1366624348
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Entity Type | Organization
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Legal Business Name | THE LAZARUS PROJECT
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 1200 FORD RD SUITE 2
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City | MINNETONKA
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State | MN
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Zip | 55305-1616
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Country | US
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Telephone | 763-519-1197
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Fax | 763-519-1198
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Provider Business Mailing Address
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Address Line | 1200 FORD RD SUITE 2
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City | MINNETONKA
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State | MN
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Zip | 55305-1616
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Country | US
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Telephone | 763-519-1197
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Fax | 763-519-1198
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | MS. BECKY EDEBURN
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Credential |
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Telephone | 763-519-1197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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