Provider Demographics
NPI:1275808206
Name:MAINS'L FISCAL SUPPORT ENTITY
Entity Type:Organization
Organization Name:MAINS'L FISCAL SUPPORT ENTITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-494-4553
Mailing Address - Street 1:7000 78TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2744
Mailing Address - Country:US
Mailing Address - Phone:763-494-4553
Mailing Address - Fax:763-416-9198
Practice Address - Street 1:7000 78TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2744
Practice Address - Country:US
Practice Address - Phone:763-494-4553
Practice Address - Fax:763-416-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA976414300Medicaid