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General NPI Number Information
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NPI Number | 1568212751
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Entity Type | Organization
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Legal Business Name | INTERFAITH OUTREACH & COMMUNITY PARTNERS
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Dates
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Enumeration Date | 03/22/2024
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 11229 HWY 55
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City | PLYMOUTH
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State | MN
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Zip | 55441-6067
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Country | US
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Telephone | 763-340-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 COUNTY ROAD 101 N
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City | PLYMOUTH
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State | MN
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Zip | 55447-2708
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Country | US
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Telephone | 763-489-7500
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | LINDSEY MAHRER
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Credential |
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Telephone | 763-489-7719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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