Provider Demographics
NPI:1467214478
Name:SERVICES FOR HOMELESSNESS AND ADDICTION REHAB EDUCATION
Entity Type:Organization
Organization Name:SERVICES FOR HOMELESSNESS AND ADDICTION REHAB EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MAI
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-456-4565
Mailing Address - Street 1:1865 OLD HUDSON RD # A3
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4308
Mailing Address - Country:US
Mailing Address - Phone:612-456-4565
Mailing Address - Fax:651-846-4517
Practice Address - Street 1:475 ETNA ST STE 9
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5845
Practice Address - Country:US
Practice Address - Phone:612-456-4565
Practice Address - Fax:651-846-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility