Basic Information
| Provider Information | |||||||||
| NPI: | 1902421662 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIAS HEALTH-HSS/HNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 166 4TH ST E STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551011474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512911979 | ||||||||
| FaxNumber: | 6512917378 | ||||||||
| Practice Location | |||||||||
| Address1: | 166 4TH ST E STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551011474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512911979 | ||||||||
| FaxNumber: | 6512917378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2020 | ||||||||
| LastUpdateDate: | 06/09/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LINDNER | ||||||||
| AuthorizedOfficialFirstName: | JODY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6512561294 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.