Provider Demographics
NPI:1386682078
Name:NEIGHBORHOOD HEALTHSOURCE
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTHSOURCE
Other - Org Name:FREMONT COMMUNITY HEALTH SERVICES, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-287-2428
Mailing Address - Street 1:3300 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2405
Mailing Address - Country:US
Mailing Address - Phone:612-588-9411
Mailing Address - Fax:612-522-6627
Practice Address - Street 1:3300 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2405
Practice Address - Country:US
Practice Address - Phone:612-588-9411
Practice Address - Fax:612-522-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN241813Medicare PIN
MNC00790Medicare PIN