1982085221 NPI number — SAINT THERESE COLLABORATIVE, LLC

Table of content: (NPI 1982085221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982085221 NPI number — SAINT THERESE COLLABORATIVE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT THERESE COLLABORATIVE, LLC
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:
1982085221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1660 HIGHWAY 100 S
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416-1529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-283-2203
Provider Business Mailing Address Fax Number:
952-224-0991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 OAKDALE AVE N
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
ROBBINSDALE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55422-2926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-983-2203
Provider Business Practice Location Address Fax Number:
952-224-0991
Provider Enumeration Date:
06/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SHELANGOSKI
Authorized Official First Name:
CAL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
952-283-2204

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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