Provider Demographics
NPI:1356919328
Name:EMERGE SUPPORT SERVICES, INC.
Entity type:Organization
Organization Name:EMERGE SUPPORT SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:RABIIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-703-8410
Mailing Address - Street 1:2233 HAMLINE AVE N STE 217
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5004
Mailing Address - Country:US
Mailing Address - Phone:651-500-1449
Mailing Address - Fax:
Practice Address - Street 1:2233 HAMLINE AVE N STE 217
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-5004
Practice Address - Country:US
Practice Address - Phone:651-500-1449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1234567OtherMENTAL HEALTH -OUT PATIENT