Provider Demographics
NPI:1588715304
Name:CHILDREN'S HOME SOCIETY & FAMILY SERVICES
Entity type:Organization
Organization Name:CHILDREN'S HOME SOCIETY & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE & ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-255-2326
Mailing Address - Street 1:1605 EUSTIS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1219
Mailing Address - Country:US
Mailing Address - Phone:651-646-7771
Mailing Address - Fax:651-255-2380
Practice Address - Street 1:2230 COMO AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1720
Practice Address - Country:US
Practice Address - Phone:651-646-7771
Practice Address - Fax:651-646-0436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN800791-1-MHC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN305472100OtherMEDICAL ASSISTANCE
MNCO4024Medicare ID - Type UnspecifiedMEDICARE