Provider Demographics
NPI:1376859660
Name:AFRICAN AMERICAN FAMILY SERVICES
Entity Type:Organization
Organization Name:AFRICAN AMERICAN FAMILY SERVICES
Other - Org Name:AFRICAN AMERICAN FAMILY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DUPAS
Authorized Official - Suffix:
Authorized Official - Credentials:TLADC
Authorized Official - Phone:612-238-2370
Mailing Address - Street 1:2616 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1628
Mailing Address - Country:US
Mailing Address - Phone:612-238-2370
Mailing Address - Fax:651-642-0043
Practice Address - Street 1:2616 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1628
Practice Address - Country:US
Practice Address - Phone:612-238-2370
Practice Address - Fax:651-642-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization