MEDICARE: CENTER FOR NURTURING AND GROWTH

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1508165747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR NURTURING AND GROWTH

Provider Business Mailing Address
First Line	:	PO BOX 4053
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-0053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1437 MARSHALL AVE STE 106
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-6345
Country	:	US
Telephone Number	:	651-276-0607
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	AHMED HASSAN
Credential	:
Telephone Number	:	651-276-0607

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	03/25/2011

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