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General NPI Number Information
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NPI Number | 1780295964
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Entity Type | Organization
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Legal Business Name | THE EXPERIENCE OF NESHAMA
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 1 WATER ST W STE 220
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City | SAINT PAUL
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State | MN
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Zip | 55107-2002
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Country | US
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Telephone | 612-418-9429
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Fax | 651-318-3637
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Provider Business Mailing Address
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Address Line | 1 WATER ST W STE 220
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City | SAINT PAUL
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State | MN
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Zip | 55107-2002
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Country | US
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Telephone | 612-418-9429
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Fax | 651-318-3637
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Authorized Official
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Title or Position | PRESIDENT
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Name | RYAN ECKDAHL
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Credential |
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Telephone | 612-418-9429
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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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