Provider Demographics
NPI:1669998357
Name:PHYLLIS WHEATLEY COMMUNITY CENTER, INC.
Entity type:Organization
Organization Name:PHYLLIS WHEATLEY COMMUNITY CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-374-4342
Mailing Address - Street 1:1301 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-4406
Mailing Address - Country:US
Mailing Address - Phone:612-374-4342
Mailing Address - Fax:612-377-9089
Practice Address - Street 1:1301 10TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-4406
Practice Address - Country:US
Practice Address - Phone:612-374-4342
Practice Address - Fax:612-377-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health