Provider Demographics
NPI:1942471370
Name:AFRICAN AMERICAN FAMILY SERVICES
Entity Type:Organization
Organization Name:AFRICAN AMERICAN FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LOFGREN
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:612-238-2302
Mailing Address - Street 1:PO BOX 8900
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-0900
Mailing Address - Country:US
Mailing Address - Phone:612-871-7878
Mailing Address - Fax:
Practice Address - Street 1:1041 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6535
Practice Address - Country:US
Practice Address - Phone:612-871-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN80113422CDT251S00000X
MN8059762CDT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN707055100OtherMN DHS PROVIDER IHENNEPIN
MN010757300OtherMNDHS PROVIDER NUMBER