1174799621 NPI number — VOLUNTEERS OF AMERICA OF MINNESOTA

Table of content: (NPI 1174799621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174799621 NPI number — VOLUNTEERS OF AMERICA OF MINNESOTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VOLUNTEERS OF AMERICA OF MINNESOTA
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:
1174799621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22426 SAINT FRANCIS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANOKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55303-9670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-753-7310
Provider Business Mailing Address Fax Number:
763-753-6529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5905 GOLDEN VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GOLDEN VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55422-4463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-225-4052
Provider Business Practice Location Address Fax Number:
888-965-5130
Provider Enumeration Date:
05/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MIHAS
Authorized Official First Name:
ATHENA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
952-945-4000

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  1163 , 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: 694319500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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