Provider Demographics
NPI:1558534024
Name:SUPPORTIVE HOUSING AND MANAGED CARE PILOT
Entity Type:Organization
Organization Name:SUPPORTIVE HOUSING AND MANAGED CARE PILOT
Other - Org Name:HEARTH CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF FINANCE AND ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-645-0676
Mailing Address - Street 1:2446 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-0001
Mailing Address - Country:US
Mailing Address - Phone:651-645-0676
Mailing Address - Fax:651-645-0677
Practice Address - Street 1:2446 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 150
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-0001
Practice Address - Country:US
Practice Address - Phone:651-645-0676
Practice Address - Fax:651-645-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management