Provider Demographics
NPI:1477611853
Name:JEWISH FAMILY & CHILDREN'S SERVICE OF MINNEAPOLIS
Entity Type:Organization
Organization Name:JEWISH FAMILY & CHILDREN'S SERVICE OF MINNEAPOLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BELICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-546-0616
Mailing Address - Street 1:5905 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4463
Mailing Address - Country:US
Mailing Address - Phone:952-546-0616
Mailing Address - Fax:952-593-1778
Practice Address - Street 1:5905 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4463
Practice Address - Country:US
Practice Address - Phone:952-546-0616
Practice Address - Fax:952-593-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNC01878101YM0800X
MN3785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN600908500Medicaid
MN575253100OtherMEDICAL ASSISTANCE
MNCO1878Medicare PIN