1821165234 NPI number — JEWISH FAMILY SERVICE OF ST. PAUL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821165234 NPI number — JEWISH FAMILY SERVICE OF ST. PAUL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEWISH FAMILY SERVICE OF ST. PAUL
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:
1821165234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1633 - 7TH ST. W.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-698-0767
Provider Business Mailing Address Fax Number:
651-698-0162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1633 7TH ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102-4227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-698-0767
Provider Business Practice Location Address Fax Number:
651-698-0162
Provider Enumeration Date:
11/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WAXMAN
Authorized Official First Name:
RENA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
651-698-0767

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251S00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 104817100 . This is a "RAMSEY COUNTY ID #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 510079800 . This is a "RAMSEY COUNTY ID #2" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".