MEDICARE: FOCUSING ON ADVOCATING, MENTORING AND EDUCATING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1265269609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOCUSING ON ADVOCATING, MENTORING AND EDUCATING

Provider Business Mailing Address
First Line	:	8501 VIRGINIA CIR N
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55426-2451
Country	:	US
Telephone Number	:	612-449-9707
Fax Number	:

Provider Business Practice Location Address
First Line	:	3859 FREMONT AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55412-2042
Country	:	US
Telephone Number	:	912-449-9707
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TAKESHA DEADWYLER
Credential	:	CPRSR, CPSS
Telephone Number	:	612-449-9707

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	09/18/2024

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Directions to “FOCUSING ON ADVOCATING, MENTORING AND EDUCATING ” Practice Location

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