Provider Demographics
NPI:1871367714
Name:12TH HOUSE HEALING SERVICES
Entity type:Organization
Organization Name:12TH HOUSE HEALING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TAYONNA
Authorized Official - Middle Name:MARTIA
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-584-0902
Mailing Address - Street 1:650 AGUIRRE ST APT 232
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-4430
Mailing Address - Country:US
Mailing Address - Phone:612-584-0902
Mailing Address - Fax:
Practice Address - Street 1:650 AGUIRRE ST APT 232
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-4430
Practice Address - Country:US
Practice Address - Phone:612-584-0902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No177F00000XOther Service ProvidersLodging
No253Z00000XAgenciesIn Home Supportive Care
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness