=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952477085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMUNIDADES LATINAS UNIDAS EN SERVICIO, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 08/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 797 7TH ST E
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55106-5014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-379-4200
-----------------------------------------------------
Fax | 651-292-0347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 797 7TH ST E
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55106-5014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-379-4200
-----------------------------------------------------
Fax | 651-292-0347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCOUNTANT II
-----------------------------------------------------
Name | AMANDA PLESKOVITCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-379-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------