Provider Demographics
NPI:1124534359
Name:MAIN STREET FAMILY SERVICES
Entity Type:Organization
Organization Name:MAIN STREET FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ALLYN
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-233-2195
Mailing Address - Street 1:400 JACKSON AVE NW STE 101
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1363
Mailing Address - Country:US
Mailing Address - Phone:763-595-1420
Mailing Address - Fax:
Practice Address - Street 1:400 JACKSON AVE NW STE 101
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1363
Practice Address - Country:US
Practice Address - Phone:763-233-2195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management