MEDICARE: KINDRED FAMILY FOCUS

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	801978-7-CPA	MN

General Provider Information

NPI Number	:	1437298668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDRED FAMILY FOCUS

Provider Business Mailing Address
First Line	:	2800 UNIVERSITY AVE SE STE 204
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-4205
Country	:	US
Telephone Number	:	218-671-1127
Fax Number	:	612-331-3520

Provider Business Practice Location Address
First Line	:	5985 RICE CREEK PKWY STE 202
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-5037
Country	:	US
Telephone Number	:	612-331-4429
Fax Number	:	612-331-3520

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. GEORGE HENDRICKSON
Credential	:
Telephone Number	:	763-350-9236

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	10/24/2018

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