Provider Demographics
NPI:1982383188
Name:SHENOAH REED
Entity Type:Organization
Organization Name:SHENOAH REED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHENOAH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-567-7786
Mailing Address - Street 1:10967 UNIVERSITY AVE NE APT F
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-1993
Mailing Address - Country:US
Mailing Address - Phone:612-567-7786
Mailing Address - Fax:763-390-0027
Practice Address - Street 1:10967 UNIVERSITY AVE NE APT F
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-1993
Practice Address - Country:US
Practice Address - Phone:612-567-7786
Practice Address - Fax:763-390-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty