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General NPI Number Information
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NPI Number | 1922409689
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Entity Type | Organization
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Legal Business Name | ASSOCIATES FOR MENTAL HEALTH
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 28 SUZANNE AVE
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127-4116
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Country | US
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Telephone | 651-815-1977
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Fax | 651-888-6959
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Provider Business Mailing Address
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Address Line | PO BOX 270234
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127-0234
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Country | US
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Telephone | 651-815-1977
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Fax | 651-888-6959
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATION
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Name | ALLYSON BOSTROM
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Credential |
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Telephone | 651-815-1977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 2913
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License Number State | MN
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