1871809152 NPI number — CEDAR RIVERSIDE PEOPLE'S CENTER

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 1871809152 NPI number — CEDAR RIVERSIDE PEOPLE'S CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR RIVERSIDE PEOPLE'S CENTER
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:
6
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:
1871809152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 20TH AVENUE SOUTH
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:
55454-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-332-4973
Provider Business Mailing Address Fax Number:
612-238-3534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3152 MINNEHAHA AVENUE
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:
55406-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-332-4973
Provider Business Practice Location Address Fax Number:
612-238-3534
Provider Enumeration Date:
08/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NOOR
Authorized Official First Name:
SAHRA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
612-332-4973

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , 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)

  • Identifier: 877361100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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