Provider Demographics
NPI:1780295964
Name:THE EXPERIENCE OF NESHAMA
Entity type:Organization
Organization Name:THE EXPERIENCE OF NESHAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-418-9429
Mailing Address - Street 1:1 WATER ST W STE 220
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2002
Mailing Address - Country:US
Mailing Address - Phone:612-418-9429
Mailing Address - Fax:651-318-3637
Practice Address - Street 1:1 WATER ST W STE 220
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2002
Practice Address - Country:US
Practice Address - Phone:612-418-9429
Practice Address - Fax:651-318-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty