Provider Demographics
NPI:1932701109
Name:AMHERST H. WILDER FOUNDATION
Entity Type:Organization
Organization Name:AMHERST H. WILDER FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER - ESAS
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-280-2357
Mailing Address - Street 1:451 LEXINGTON PKWY N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4636
Mailing Address - Country:US
Mailing Address - Phone:651-280-2357
Mailing Address - Fax:
Practice Address - Street 1:451 LEXINGTON PKWY N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4636
Practice Address - Country:US
Practice Address - Phone:651-280-2357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management