Provider Demographics
NPI:1275634230
Name:FAMILYWISE SERVICES
Entity Type:Organization
Organization Name:FAMILYWISE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-877-7827
Mailing Address - Street 1:3036 UNIVERSITY AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3316
Mailing Address - Country:US
Mailing Address - Phone:612-617-0191
Mailing Address - Fax:612-617-0193
Practice Address - Street 1:3036 UNIVERSITY AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3316
Practice Address - Country:US
Practice Address - Phone:612-617-0191
Practice Address - Fax:612-617-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN060108001OtherMETROPOLITAN HEALTH PLAN
MN198428400Medicaid
MN1983OtherUCARE MINNESOTA
MN835556800OtherMEDICAL ASSISTANCE