Provider Demographics
NPI:1902203177
Name:THE EMILY PROGRAM PC
Entity Type:Organization
Organization Name:THE EMILY PROGRAM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:888-364-5977
Mailing Address - Street 1:1295 BANDANA BLVD. W.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1737
Mailing Address - Country:US
Mailing Address - Phone:866-364-5977
Mailing Address - Fax:
Practice Address - Street 1:2141 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-5995
Practice Address - Country:US
Practice Address - Phone:888-364-5977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility