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General NPI Number Information
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NPI Number | 1437352242
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Entity Type | Organization
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Legal Business Name | MODEL CITIES OF ST. PAUL, INC.
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 839 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-4808
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Country | US
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Telephone | 651-632-8350
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Fax | 651-523-0081
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Provider Business Mailing Address
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Address Line | 839 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-4808
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Country | US
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Telephone | 651-632-8350
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Fax | 651-523-0081
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. BEVERLEY OLIVER HAWKINS
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Credential |
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Telephone | 651-632-8343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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