Provider Demographics
NPI:1821124447
Name:SHERIFFS YOUTH PROGRAMS OF MINNESOTA
Entity Type:Organization
Organization Name:SHERIFFS YOUTH PROGRAMS OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:651-552-5742
Mailing Address - Street 1:2925 BUCKLEY WAY
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-2018
Mailing Address - Country:US
Mailing Address - Phone:651-552-5742
Mailing Address - Fax:651-552-5741
Practice Address - Street 1:2925 BUCKLEY WAY
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-2018
Practice Address - Country:US
Practice Address - Phone:651-552-5742
Practice Address - Fax:651-552-5741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1036867-1-CRF177F00000X
MN806195-3-CRF177F00000X
MN1042569-1-CRF177F00000X
MNDOC LIC FOR VOC SKIL177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty