Provider Demographics
NPI:1336200922
Name:ALDRICH BOARDING CARE HOME, LLC
Entity Type:Organization
Organization Name:ALDRICH BOARDING CARE HOME, LLC
Other - Org Name:BRIDGES MN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-913-5990
Mailing Address - Street 1:1932 UNIVERSITY AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:612-695-6041
Mailing Address - Fax:651-528-8427
Practice Address - Street 1:1932 UNIVERSITY AVENUE WEST
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:612-695-6041
Practice Address - Fax:651-528-8427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN800642-2-RS320600000X
320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN535543500OtherSTATE PROVIDER NUMBER