Provider Demographics
NPI:1437239803
Name:CATHOLIC CHARITIES OF ST PAUL/MPLS
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF ST PAUL/MPLS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-204-8387
Mailing Address - Street 1:1200 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2513
Mailing Address - Country:US
Mailing Address - Phone:612-204-8387
Mailing Address - Fax:
Practice Address - Street 1:1121 E 46TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3562
Practice Address - Country:US
Practice Address - Phone:612-204-8278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF ST PAUL/MPLS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-17
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN50-17097OtherRESIDENTIAL TREATMENT