1063437564 NPI number — SOUTH CENTRAL HUMAN RELATIONS CENTER

Table of content: (NPI 1063437564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063437564 NPI number — SOUTH CENTRAL HUMAN RELATIONS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CENTRAL HUMAN RELATIONS 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:
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:
1063437564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 FLORENCE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWATONNA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55060-4704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-451-2630
Provider Business Mailing Address Fax Number:
507-455-8133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 FLORENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWATONNA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55060-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-451-2630
Provider Business Practice Location Address Fax Number:
507-455-8133
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MERXBAUER
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
507-451-2630

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  802265-1-MHC , 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: 205055200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23107 . This is a "STATE ID#" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 116875 . This is a "UCARE ID#" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 9016593 . This is a "MN TAX ID #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 35145HU . This is a "BLUE CROSS BLUE SHIELD#" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com