Provider Demographics
NPI:1992887863
Name:MINNESOTA INDIAN WOMEN'S RESOURCE CENTER
Entity type:Organization
Organization Name:MINNESOTA INDIAN WOMEN'S RESOURCE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-728-2006
Mailing Address - Street 1:2300 15TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3960
Mailing Address - Country:US
Mailing Address - Phone:612-728-2000
Mailing Address - Fax:612-728-2039
Practice Address - Street 1:2300 15TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3960
Practice Address - Country:US
Practice Address - Phone:612-728-2000
Practice Address - Fax:612-728-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN801557-1-CDT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8441666OtherMEDICA
MN0782704OtherHENNEPIN COUNTY CHEMICAL