Provider Demographics
NPI:1649091588
Name:MERGING RIVERS LLC
Entity type:Organization
Organization Name:MERGING RIVERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:952-900-2749
Mailing Address - Street 1:4905 31ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1403
Mailing Address - Country:US
Mailing Address - Phone:952-900-2749
Mailing Address - Fax:952-333-7493
Practice Address - Street 1:2420 CLEVELAND AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2727
Practice Address - Country:US
Practice Address - Phone:952-900-2749
Practice Address - Fax:952-333-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty