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General NPI Number Information
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NPI Number | 1679817936
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Entity Type | Organization
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Legal Business Name | THE JONAS CENTER
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 925 12TH ST E
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City | GLENCOE
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State | MN
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Zip | 55336-2315
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Country | US
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Telephone | 320-864-6139
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Fax |
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Provider Business Mailing Address
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Address Line | 925 12TH ST E
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City | GLENCOE
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State | MN
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Zip | 55336-2315
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Country | US
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Telephone | 320-864-6139
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JAMES JONAS
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Credential | LICSW
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Telephone | 952-361-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 02425
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License Number State | MN
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