Provider Demographics
NPI:1992930911
Name:HENNEPIN ADULT DAY CARE SERVICES CORP
Entity type:Organization
Organization Name:HENNEPIN ADULT DAY CARE SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:651-646-8961
Mailing Address - Street 1:978 DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6544
Mailing Address - Country:US
Mailing Address - Phone:651-646-8961
Mailing Address - Fax:
Practice Address - Street 1:700 10TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1745
Practice Address - Country:US
Practice Address - Phone:651-646-8961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNAPPLYING261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care