Provider Demographics
NPI:1922409689
Name:ASSOCIATES FOR MENTAL HEALTH
Entity Type:Organization
Organization Name:ASSOCIATES FOR MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-815-1977
Mailing Address - Street 1:PO BOX 270234
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-0234
Mailing Address - Country:US
Mailing Address - Phone:651-815-1977
Mailing Address - Fax:651-888-6959
Practice Address - Street 1:28 SUZANNE AVE
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-4116
Practice Address - Country:US
Practice Address - Phone:651-815-1977
Practice Address - Fax:651-888-6959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2913253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care