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General NPI Number Information
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NPI Number | 1801082847
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Entity Type | Organization
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Legal Business Name | MISSIONS INC. PROGRAMS
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 3409 E MEDICINE LAKE BLVD
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City | PLYMOUTH
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State | MN
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Zip | 55441-2307
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Country | US
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Telephone | 763-559-1883
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Fax | 763-559-1195
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Provider Business Mailing Address
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Address Line | 3409 E MEDICINE LAKE BLVD
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City | PLYMOUTH
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State | MN
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Zip | 55441-2307
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Country | US
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Telephone | 763-559-1883
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Fax | 763-559-1195
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. PATRICIA J MURPHY
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Credential |
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Telephone | 763-559-1883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 8015661-DS
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License Number State | MN
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