Provider Demographics
NPI:1073201836
Name:SOCIAL SERVICES OF MINNESOTA
Entity Type:Organization
Organization Name:SOCIAL SERVICES OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SALVATORE
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPRSR
Authorized Official - Phone:612-401-4864
Mailing Address - Street 1:2168 NORTONIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-3550
Mailing Address - Country:US
Mailing Address - Phone:612-401-4864
Mailing Address - Fax:612-401-4864
Practice Address - Street 1:2168 NORTONIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-3550
Practice Address - Country:US
Practice Address - Phone:612-401-4864
Practice Address - Fax:612-401-4864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care