Provider Demographics
NPI:1154559276
Name:MAI'S ADULT FOSTER CARE
Entity type:Organization
Organization Name:MAI'S ADULT FOSTER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAI
Authorized Official - Middle Name:CHA
Authorized Official - Last Name:MOUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-235-5287
Mailing Address - Street 1:1657 DULUTH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1117
Mailing Address - Country:US
Mailing Address - Phone:651-235-5287
Mailing Address - Fax:651-771-7974
Practice Address - Street 1:1657 DULUTH ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-1117
Practice Address - Country:US
Practice Address - Phone:651-235-5287
Practice Address - Fax:651-771-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1042011-2-AFC253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency