Provider Demographics
NPI:1720135965
Name:COMMUNITY INVOLVEMENT PROGRAMS
Entity Type:Organization
Organization Name:COMMUNITY INVOLVEMENT PROGRAMS
Other - Org Name:CDCS/FSE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-362-4420
Mailing Address - Street 1:1600 BROADWAY ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2617
Mailing Address - Country:US
Mailing Address - Phone:612-362-4420
Mailing Address - Fax:
Practice Address - Street 1:1600 BROADWAY ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2617
Practice Address - Country:US
Practice Address - Phone:612-362-4420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN782657501Medicaid