1487067153 NPI number — CLIENT CENTERED CARE

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 1487067153 NPI number — CLIENT CENTERED CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLIENT CENTERED CARE
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:
1487067153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
393 DUNLAP STREET NORTH
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-600-3869
Provider Business Mailing Address Fax Number:
651-797-4308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
393 DUNLAP ST N
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55104-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-600-3869
Provider Business Practice Location Address Fax Number:
651-797-4308
Provider Enumeration Date:
06/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ELY
Authorized Official First Name:
BRADLY
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
DIRECTOR OF NURSING
Authorized Official Telephone Number:
651-600-3869

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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