Provider Demographics
NPI:1427226687
Name:DOR
Entity Type:Organization
Organization Name:DOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TOD
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:DEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-224-9684
Mailing Address - Street 1:1660 SOUTH HIGHWAY 100
Mailing Address - Street 2:SUITE 430
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:612-332-4805
Mailing Address - Fax:612-342-2422
Practice Address - Street 1:1660 SOUTH HIGHWAY 100
Practice Address - Street 2:SUITE 430
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:612-332-4805
Practice Address - Fax:612-342-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty