Provider Demographics
NPI:1700313756
Name:MENAGES LLC
Entity Type:Organization
Organization Name:MENAGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDITH RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TCHOUICHOUI TONOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-451-4280
Mailing Address - Street 1:6802 158TH ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6578
Mailing Address - Country:US
Mailing Address - Phone:952-451-4280
Mailing Address - Fax:
Practice Address - Street 1:6802 158TH ST W
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6578
Practice Address - Country:US
Practice Address - Phone:952-451-4280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1086828-1-HCBS101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty