MEDICARE: MSOCS-BLAINE

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	315P00000X	Intellectual Disabilities Intermediate Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508939331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSOCS-BLAINE

Provider Business Mailing Address
First Line	:	PO BOX 64979
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55164-0979
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12949 KENYON ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55449-4991
Country	:	US
Telephone Number	:	763-755-0233
Fax Number	:

Authorized Official
Title or Position	:	RESIDENTIAL PROG SVCS DIRECTOR
Name	:	ROGER DENEEN
Credential	:
Telephone Number	:	651-582-1857

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	06/18/2008

Similar Medicare Providers

1659736627 — 1ST CHOICE HEALTH
Practice Location Address:

12937 KENYON ST NE
BLAINE, MN
55449-4991

Practice Phone: 612-532-4086
Practice Fax:

1134272586 — GEORGIANN KAE JENSEN O.D.
Practice Location Address:

12170 ABERDEEN ST NE
MINNEAPOLIS, MN
55449-4716

Practice Phone: 763-757-7000
Practice Fax: 763-757-3328

1528394707 — DR. JULIE ANN EIBENSTEINER DPT
Practice Location Address:

11304 DAVENPORT CIRCLE NE #A
MINNEAPOLIS, MN
55449

Practice Phone: 651-592-1625
Practice Fax:

1194001586 — PATRICIA BRAUN PHARMD
Practice Location Address:

4202 PHEASANT RIDGE DR NE
MINNEAPOLIS, MN
55449-4529

Practice Phone: 651-255-1498
Practice Fax:

1437498896 — CHRISTINA GWENN COPELAND MS
Practice Location Address:

1969 112TH CIR NE
MINNEAPOLIS, MN
55449-6112

Practice Phone: 636-734-5511
Practice Fax:

1386004968 — MRS. MICHELLE NICOLE FERREL M.S.W. L.I.C.S.W
Practice Location Address:

11806 ABERDEEN ST. NE , SUITE 220
MINNEAPOLIS, MN
55449-1547

Practice Phone: 612-541-7106
Practice Fax:

Directions to “MSOCS-BLAINE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.