=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669698262
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKILLS FOR TOMORROW HIGH SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 547 WHEELER ST N
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-1733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-647-6000
-----------------------------------------------------
Fax | 651-645-2388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 547 WHEELER ST N
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-1733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-647-6000
-----------------------------------------------------
Fax | 651-645-2388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. CLAUDE MADDOX
-----------------------------------------------------
Credential | L.S.W.
-----------------------------------------------------
Telephone | 651-647-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------