Provider Demographics
NPI:1588035174
Name:CHRIS NDEDE KOJO BAIDOE
Entity Type:Organization
Organization Name:CHRIS NDEDE KOJO BAIDOE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:NDEDE KOJO
Authorized Official - Last Name:BAIDOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-329-5265
Mailing Address - Street 1:1114 27TH AVE S APT 25
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560
Mailing Address - Country:US
Mailing Address - Phone:218-329-5265
Mailing Address - Fax:
Practice Address - Street 1:1114 27TH AVE S APT 25
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-4656
Practice Address - Country:US
Practice Address - Phone:218-329-5256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1078559-2-HCBS253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency