Provider Demographics
NPI:1992150080
Name:MINNESOTA MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:MINNESOTA MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HOPPE
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:952-220-5683
Mailing Address - Street 1:990 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-3987
Mailing Address - Country:US
Mailing Address - Phone:952-220-5683
Mailing Address - Fax:
Practice Address - Street 1:990 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-3987
Practice Address - Country:US
Practice Address - Phone:952-220-5683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health