Provider Demographics
NPI:1174863740
Name:CENTER FOR VICTIMS OF TORTURE CLINIC PARTNERSHIP
Entity Type:Organization
Organization Name:CENTER FOR VICTIMS OF TORTURE CLINIC PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-436-4869
Mailing Address - Street 1:1983 SLOAN PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2087
Mailing Address - Country:US
Mailing Address - Phone:612-436-4845
Mailing Address - Fax:612-436-2600
Practice Address - Street 1:1983 SLOAN PL
Practice Address - Street 2:SUITE 1
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2087
Practice Address - Country:US
Practice Address - Phone:612-436-4845
Practice Address - Fax:612-436-2600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR VICTIMS OF TORTURE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management