Provider Demographics
NPI:1477929990
Name:HATCH LIFE LLC
Entity Type:Organization
Organization Name:HATCH LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MAIMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FANT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:612-888-3133
Mailing Address - Street 1:4590 SCOTT TRAIL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122
Mailing Address - Country:US
Mailing Address - Phone:612-888-3133
Mailing Address - Fax:
Practice Address - Street 1:4590 SCOTT TRL
Practice Address - Street 2:200
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3331
Practice Address - Country:US
Practice Address - Phone:612-888-3133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREGNANCY & POSTPARTUM SUPPORT MN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-19
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN228481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty