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General NPI Number Information
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NPI Number | 1396617098
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Entity Type | Organization
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Legal Business Name | STATE OF MINNESOTA DHS
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 10101 1ST AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55420-4907
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Country | US
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Telephone | 952-948-2040
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 LABORE RD
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55110-5186
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Country | US
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Telephone | 651-539-7200
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Fax | 651-431-7505
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Authorized Official
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Title or Position | SKILLS DEVELOPMENT SPECIALIST
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Name | DENISHA J ANDERSON
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Credential |
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Telephone | 952-948-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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