Provider Demographics
NPI:1366624348
Name:THE LAZARUS PROJECT
Entity Type:Organization
Organization Name:THE LAZARUS PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-519-1197
Mailing Address - Street 1:1200 FORD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1616
Mailing Address - Country:US
Mailing Address - Phone:763-519-1197
Mailing Address - Fax:763-519-1198
Practice Address - Street 1:1200 FORD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1616
Practice Address - Country:US
Practice Address - Phone:763-519-1197
Practice Address - Fax:763-519-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN246L9HOOtherBLUE CROSS BLUE SHIELD