Provider Demographics
NPI:1528575149
Name:EAST SIDE NEIGHBORHOOD SERVICES
Entity Type:Organization
Organization Name:EAST SIDE NEIGHBORHOOD SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-781-6011
Mailing Address - Street 1:1700 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1139
Mailing Address - Country:US
Mailing Address - Phone:612-781-6011
Mailing Address - Fax:612-787-4018
Practice Address - Street 1:1700 2ND ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1139
Practice Address - Country:US
Practice Address - Phone:612-781-6011
Practice Address - Fax:612-787-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare