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General NPI Number Information
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NPI Number | 1891152039
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Entity Type | Organization
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Legal Business Name | NURTURING HOUSE, LLC
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 540 FAIRVIEW AVE N STE 303
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City | SAINT PAUL
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State | MN
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Zip | 55104-1796
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Country | US
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Telephone | 651-756-1473
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Fax | 651-756-7224
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Provider Business Mailing Address
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Address Line | 540 FAIRVIEW AVE N STE 303
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City | SAINT PAUL
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State | MN
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Zip | 55104-1796
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Country | US
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Telephone | 651-756-1473
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Fax | 651-756-7224
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Authorized Official
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Title or Position | MANAGEMENT OFFICIAL
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Name | FATHIA J WARSAME
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Credential |
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Telephone | 651-756-1473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 1077275
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License Number State | MN
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