Provider Demographics
NPI:1124111729
Name:CENTER FOR VICTIMS OF TORTURE
Entity type:Organization
Organization Name:CENTER FOR VICTIMS OF TORTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KA
Authorized Official - Middle Name:
Authorized Official - Last Name:THAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-436-4860
Mailing Address - Street 1:649 DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6631
Mailing Address - Country:US
Mailing Address - Phone:612-436-4840
Mailing Address - Fax:
Practice Address - Street 1:649 DAYTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6631
Practice Address - Country:US
Practice Address - Phone:612-436-4840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM22572OtherHEALTH PARTNERS
MN120700OtherUCARE
MN243513600Medicaid
MN318LOCEOtherMN BCBS
MNC02056Medicare ID - Type UnspecifiedMN MCARE