Provider Demographics
NPI:1487292322
Name:FORTUNE RELIEF AND YOUTH EMPOWERMENT ORGANIZATION
Entity type:Organization
Organization Name:FORTUNE RELIEF AND YOUTH EMPOWERMENT ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:UKASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-213-9312
Mailing Address - Street 1:2910 PILLSBURY AVE S, SUITE 432
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-5504
Mailing Address - Country:US
Mailing Address - Phone:612-213-9312
Mailing Address - Fax:
Practice Address - Street 1:2910 PILLSBURY AVE S
Practice Address - Street 2:SUITE 432
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-5504
Practice Address - Country:US
Practice Address - Phone:612-213-9312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)