Provider Demographics
NPI:1003266321
Name:HEALTHEAST ST JOSEPHS HOSPITAL
Entity Type:Organization
Organization Name:HEALTHEAST ST JOSEPHS HOSPITAL
Other - Org Name:HEALTHEAST ST JOSEPHS BEHAVIORAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:SVP, CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-232-2205
Mailing Address - Street 1:45 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1062
Mailing Address - Country:US
Mailing Address - Phone:651-232-3000
Mailing Address - Fax:
Practice Address - Street 1:45 10TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1062
Practice Address - Country:US
Practice Address - Phone:651-232-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHEAST CARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-17
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN375732273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit