Provider Demographics
NPI: | 1023370830 |
---|---|
Name: | SAINT ANDREWS HOUSE |
Entity Type: | Organization |
Organization Name: | SAINT ANDREWS HOUSE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DAWN |
Authorized Official - Middle Name: | MARIE |
Authorized Official - Last Name: | ROGOSHESKE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN |
Authorized Official - Phone: | 320-963-3702 |
Mailing Address - Street 1: | 1330 86TH ST NW |
Mailing Address - Street 2: | |
Mailing Address - City: | BUFFALO |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55313-2744 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 320-963-3702 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 612 W 5TH ST |
Practice Address - Street 2: | |
Practice Address - City: | MONTICELLO |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55362-8540 |
Practice Address - Country: | US |
Practice Address - Phone: | 763-295-6001 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-06-08 |
Last Update Date: | 2012-06-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 1050473-1-AFC | 253J00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 253J00000X | Agencies | Foster Care Agency |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MN | A534197000 | Other | UMPI |