1437298668 NPI number — KINDRED FAMILY FOCUS

Table of content: (NPI 1437298668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437298668 NPI number — KINDRED FAMILY FOCUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINDRED FAMILY FOCUS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437298668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5985 RICE CREEK PKWY STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHOREVIEW
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55126-5037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-331-4429
Provider Business Practice Location Address Fax Number:
612-331-3520
Provider Enumeration Date:
02/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENDRICKSON
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
763-350-9236

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  801978-7-CPA , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)