Provider Demographics
NPI:1598823767
Name:AMHERST H. WILDER FOUNDATION
Entity Type:Organization
Organization Name:AMHERST H. WILDER FOUNDATION
Other - Org Name:WILDER HOMEMAKER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-642-4000
Mailing Address - Street 1:650 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-290-8666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN767022200OtherMEDICAL ASSISTANCE
MN767022200OtherMEDICAL ASSISTANCE
MN4990079Medicare UPIN