1184097479 NPI number — STEP FORWARD, INCORPORATED

Table of content: (NPI 1184097479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184097479 NPI number — STEP FORWARD, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEP FORWARD, INCORPORATED
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:
1184097479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3307 UNIVERSITY AVENUE SE
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-315-2242
Provider Business Mailing Address Fax Number:
612-979-2613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3307 UNIVERSITY AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55414-3325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-315-2242
Provider Business Practice Location Address Fax Number:
612-979-2613
Provider Enumeration Date:
11/09/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STEPNEY
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
OWNWR
Authorized Official Telephone Number:
612-230-4165

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  HFID-31947 , 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)