Provider Demographics
NPI:1114948833
Name:HEALTHEAST ST. JOSEPH'S HOSPITAL
Entity Type:Organization
Organization Name:HEALTHEAST ST. JOSEPH'S HOSPITAL
Other - Org Name:HEALTHEAST HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-232-2250
Mailing Address - Street 1:45 10TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1004
Mailing Address - Country:US
Mailing Address - Phone:651-232-3312
Mailing Address - Fax:651-232-3494
Practice Address - Street 1:45 10TH STREET WEST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1004
Practice Address - Country:US
Practice Address - Phone:651-232-3312
Practice Address - Fax:651-232-3494
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHEAST ST. JOSEPH'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330330251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN714555100Medicaid
MN241504Medicare ID - Type Unspecified