Provider Demographics
NPI:1851644991
Name:MINNESOTA COMMUNITY SERVICES
Entity Type:Organization
Organization Name:MINNESOTA COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIRURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-583-3264
Mailing Address - Street 1:PO BOX 782
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-0782
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:952-236-6675
Practice Address - Street 1:910 1ST ST S UNIT 782
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7797
Practice Address - Country:US
Practice Address - Phone:952-583-3264
Practice Address - Fax:952-236-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health