Provider Demographics
NPI:1841761954
Name:HENNEPIN COUNTY
Entity Type:Organization
Organization Name:HENNEPIN COUNTY
Other - Org Name:HARRIET TUBMAN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-348-8824
Mailing Address - Street 1:525 PORTLAND AVE # MC963
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1533
Mailing Address - Country:US
Mailing Address - Phone:612-348-5553
Mailing Address - Fax:612-677-6299
Practice Address - Street 1:3111 FIRST AVE. SO.
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2055
Practice Address - Country:US
Practice Address - Phone:612-348-5553
Practice Address - Fax:612-677-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)