Provider Demographics
NPI:1003908260
Name:THE LAZARUS PROJECT
Entity Type:Organization
Organization Name:THE LAZARUS PROJECT
Other - Org Name:THE CHILDREN'S AUTISM REHABILITATION EDUCATION,
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-452-1500
Mailing Address - Street 1:2520 PILOT KNOB RD
Mailing Address - Street 2:STE 190
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120
Mailing Address - Country:US
Mailing Address - Phone:651-452-1500
Mailing Address - Fax:651-452-1502
Practice Address - Street 1:2520 PILOT KNOB RD
Practice Address - Street 2:STE 190
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120
Practice Address - Country:US
Practice Address - Phone:651-452-1500
Practice Address - Fax:651-452-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN085L4LAOtherBCBS-MN
MN609878900Medicaid
MN609878900OtherMMIS-DHS