Provider Demographics
NPI:1437352242
Name:MODEL CITIES OF ST. PAUL, INC.
Entity Type:Organization
Organization Name:MODEL CITIES OF ST. PAUL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLEY
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-632-8343
Mailing Address - Street 1:839 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4808
Mailing Address - Country:US
Mailing Address - Phone:651-632-8350
Mailing Address - Fax:651-523-0081
Practice Address - Street 1:839 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4808
Practice Address - Country:US
Practice Address - Phone:651-632-8350
Practice Address - Fax:651-523-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty