1962408906 NPI number — OPEN CITIES HEALTH CENTER, INC. - RICE STREET

Table of content: (NPI 1962408906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962408906 NPI number — OPEN CITIES HEALTH CENTER, INC. - RICE STREET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN CITIES HEALTH CENTER, INC. - RICE STREET
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:
1962408906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 NORTH DUNLAP STREET
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:
55104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-290-9200
Provider Business Mailing Address Fax Number:
651-290-9210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
916 RICE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-290-9200
Provider Business Practice Location Address Fax Number:
651-290-9210
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PLATTEN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
651-290-9245

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QF0400X , with the licence number: 052730 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 666253600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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