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1396617098 NPI number — STATE OF MINNESOTA DHS

NPI Number: 1396617098
Health Care Provider/Practitioner: STATE OF MINNESOTA DHS

Information about “1396617098” NPI (STATE OF MINNESOTA DHS) exists in 1396617098 in HTML format HTML  |  1396617098 in plain Text format TXT  |  1396617098 in PDF (Portable Document Format) PDF  |  1396617098 in an XML format XML  formats.

NPI Number : 1396617098 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396617098",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "STATE OF MINNESOTA DHS",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3200 LABORE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VADNAIS HEIGHTS",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55110-5186",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "651-539-7200",
    "MailingAddressFaxNumber": "651-431-7505",
    "FirstLinePracticeLocationAddress": "10101 1ST AVE S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BLOOMINGTON",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55420-4907",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "952-948-2040",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/22/2025",
    "LastUpdateDate": "09/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ANDERSON",
    "AuthorizedOfficialFirstName": "DENISHA",
    "AuthorizedOfficialMiddleName": "J",
    "AuthorizedOfficialTitle": "SKILLS DEVELOPMENT SPECIALIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "952-948-2040",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "320900000X",
        "TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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