=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972745818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METROPOLITAN CENTER FOR INDEPENDENT LIVING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2009
-----------------------------------------------------
Last Update Date | 03/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 UNIVERSITY AVE W STE 16
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-3834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-603-2014
-----------------------------------------------------
Fax | 651-603-2014
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 UNIVERSITY AVE W STE 16
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-3834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-603-2014
-----------------------------------------------------
Fax | 651-603-2014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HR/FISCAL MANAGER
-----------------------------------------------------
Name | TANYA SWEDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-603-2014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------