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General NPI Number Information
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NPI Number | 1992878714
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Entity Type | Organization
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Legal Business Name | MSOCS-BLOOMINGTON
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 8634 OAKLAND AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55420-3030
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Country | US
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Telephone | 952-881-5214
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 64979
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City | SAINT PAUL
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State | MN
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Zip | 55164-0979
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RESIDENTIAL PROG SVCS DIRECTOR
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Name | ROGER DENEEN
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Credential |
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Telephone | 651-582-1857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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