Provider Demographics
NPI: | 1467874461 |
---|---|
Name: | CLARION4 |
Entity Type: | Organization |
Organization Name: | CLARION4 |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAMIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CHRISTIANSEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 612-998-4948 |
Mailing Address - Street 1: | 504 E 73RD ST |
Mailing Address - Street 2: | #1 |
Mailing Address - City: | RICHFIELD |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55423-3273 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 612-998-4948 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 504 E 73RD ST |
Practice Address - Street 2: | #1 |
Practice Address - City: | RICHFIELD |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55423-3273 |
Practice Address - Country: | US |
Practice Address - Phone: | 612-998-4948 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-01-09 |
Last Update Date: | 2014-01-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | |
No | 251B00000X | Agencies | Case Management | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
No | 252Y00000X | Agencies | Early Intervention Provider Agency |