Provider Demographics
NPI:1952549925
Name:COLEMAN INVESTMENT
Entity type:Organization
Organization Name:COLEMAN INVESTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:05-29-1959
Authorized Official - Phone:612-968-6205
Mailing Address - Street 1:4001 WILLOW RD N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1239
Mailing Address - Country:US
Mailing Address - Phone:612-968-6205
Mailing Address - Fax:
Practice Address - Street 1:4001 WILLOW RD N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1239
Practice Address - Country:US
Practice Address - Phone:612-968-6205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:9781267
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9781267OtherTIN