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NPI Code Detail

MEDICARE: 180 DEGREES, INC

MEDICARE: 180 DEGREES, INC
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
1320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1578958419
Entity Type Code : Organization
Provider Name (Legal Business Name) : 180 DEGREES, INC
Provider Business Mailing Address
First Line : 1281 7TH ST E
Second Line :
City : SAINT PAUL
State : MN
Zip : 55106-4039
Country : US
Telephone Number : 651-332-5539
Fax Number :
Provider Business Practice Location Address
First Line : 1281 7TH ST E
Second Line :
City : SAINT PAUL
State : MN
Zip : 55106-4039
Country : US
Telephone Number : 651-332-5539
Fax Number :
Authorized Official
Title or Position : CEO
Name : RICHARD GARDELL
Credential :
Telephone Number : 612-813-5010
Provider Enumeration Date : 03/30/2015
Last Update Date : 03/30/2015

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Directions to “180 DEGREES, INC ” Practice Location

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