Provider Demographics
NPI:1447317029
Name:CHILDREN'S HOME SOCIETY & FAMILY SERVICES
Entity type:Organization
Organization Name:CHILDREN'S HOME SOCIETY & FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-255-2335
Mailing Address - Street 1:7600 BOONE AVE N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-4563
Mailing Address - Country:US
Mailing Address - Phone:763-515-2441
Mailing Address - Fax:763-515-2442
Practice Address - Street 1:7600 BOONE AVE N
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-4563
Practice Address - Country:US
Practice Address - Phone:763-515-2441
Practice Address - Fax:763-515-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04376FAOtherBCBS INSURANCE
MN84-48904OtherUBH INSURANCE
MN19156OtherMHP INSURANCE
MN55607OtherHEALTH PARTNERS INSURANCE
MN102312OtherU-CARE INSURANCE
MN265355900Medicaid