=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396443883
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METROPOLITAN ADULT HEALTH SERVICES LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2023
-----------------------------------------------------
Last Update Date | 12/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 COUNTY ROAD 10 STE 200A
-----------------------------------------------------
City | BROOKLYN CENTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55429-3065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-447-1063
-----------------------------------------------------
Fax | 763-592-8099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3300 COUNTY ROAD 10 STE 200A
-----------------------------------------------------
City | BROOKLYN CENTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55429-3065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-447-1063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT FOR ADMINISTRATION
-----------------------------------------------------
Name | MR. EDMOND R GRAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 176-344-7106
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------