Provider Demographics
NPI:1558510859
Name:WAPITI MEADOWS COMMUNITY TECHNOLOGIES AND SERVICES
Entity Type:Organization
Organization Name:WAPITI MEADOWS COMMUNITY TECHNOLOGIES AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-383-1175
Mailing Address - Street 1:1403 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-1911
Mailing Address - Country:US
Mailing Address - Phone:507-437-2827
Mailing Address - Fax:507-437-2829
Practice Address - Street 1:1403 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1911
Practice Address - Country:US
Practice Address - Phone:507-437-2827
Practice Address - Fax:507-437-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12812251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management