Provider Demographics
NPI:1871664722
Name:SOUTH METRO HUMAN SERVICES DBA RADIAS HEALTH
Entity Type:Organization
Organization Name:SOUTH METRO HUMAN SERVICES DBA RADIAS HEALTH
Other - Org Name:HENNEPIN COUNTY ACT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-256-1234
Mailing Address - Street 1:2021 EAST HENNEPIN AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413
Mailing Address - Country:US
Mailing Address - Phone:612-435-7200
Mailing Address - Fax:612-435-7201
Practice Address - Street 1:2021 E HENNEPIN AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2700
Practice Address - Country:US
Practice Address - Phone:612-435-7200
Practice Address - Fax:612-435-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN056650100Medicaid