Provider Demographics
NPI:1194213280
Name:AMHERST H. WILDER FOUNDATION
Entity Type:Organization
Organization Name:AMHERST H. WILDER FOUNDATION
Other - Org Name:HOUSING SUPPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KETTUNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-280-2310
Mailing Address - Street 1:451 LEXINGTON PKWY N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4636
Mailing Address - Country:US
Mailing Address - Phone:651-280-2357
Mailing Address - Fax:
Practice Address - Street 1:LINCOLN PLACE
Practice Address - Street 2:1997 GOLD TRAIL
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122
Practice Address - Country:US
Practice Address - Phone:651-280-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSING SUPPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN177F00000X
177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging