Provider Demographics
NPI:1972277911
Name:AMERICAN INDIAN COMMUNITY DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:AMERICAN INDIAN COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:MCELVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-843-2112
Mailing Address - Street 1:1508 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2157
Mailing Address - Country:US
Mailing Address - Phone:612-843-2112
Mailing Address - Fax:
Practice Address - Street 1:2012 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3101
Practice Address - Country:US
Practice Address - Phone:612-813-1610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty