Provider Demographics
NPI:1376769778
Name:OPEN CITIES HEALTH CENTER, INC.
Entity type:Organization
Organization Name:OPEN CITIES HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-290-2111
Mailing Address - Street 1:409 N DUNLAP STREET
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4201
Mailing Address - Country:US
Mailing Address - Phone:651-489-8021
Mailing Address - Fax:651-489-4402
Practice Address - Street 1:916 RICE STREET
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-5425
Practice Address - Country:US
Practice Address - Phone:651-290-9200
Practice Address - Fax:651-290-9210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPEN CITIES HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3432431261QC1500X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN048695700Medicaid
MN241825Medicare ID - Type Unspecified