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NPI Code Detail

MEDICARE: BASIC NEEDS

MEDICARE: BASIC NEEDS
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
1252Y00000XEarly Intervention Provider Agency1009291MN

General Provider Information

NPI Number : 1417489212
Entity Type Code : Organization
Provider Name (Legal Business Name) : BASIC NEEDS
Provider Business Mailing Address
First Line : 3333 N 4TH ST STE 25
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55412-2615
Country : US
Telephone Number : 612-767-8671
Fax Number : 612-827-1215
Provider Business Practice Location Address
First Line : 3333 N 4TH ST STE 25
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55412-2615
Country : US
Telephone Number : 612-767-8671
Fax Number : 612-827-1215
Authorized Official
Title or Position : ADMINISTRATOR
Name : CHERLEIGH ANN CARPENTER
Credential : MHP
Telephone Number : 612-998-6300
Provider Enumeration Date : 03/30/2017
Last Update Date : 03/04/2018

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Directions to “BASIC NEEDS ” Practice Location

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