| Hope - Waivered | |
|
157 Roosevelt Rd Suite 300 Saint Cloud MN 56301-5478 | |
| (320) 240-3324 | |
| (320) 240-3339 |
| Full Name | Hope - Waivered |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 157 Roosevelt Rd, Saint Cloud, Minnesota |
| Authorized Official Name and Position | Judy Dillman (BUSINESS OFFICE MANAGER) |
| Authorized Official Contact | 3206501545 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hope - Waivered Po Box 2390 Saint Cloud MN 56302-2390 Ph: (320) 650-1550 | Hope - Waivered 157 Roosevelt Rd Suite 300 Saint Cloud MN 56301-5478 Ph: (320) 240-3324 |
| NPI Number | 1003944620 |
|---|---|
| Provider Enumeration Date | 03/02/2007 |
| Last Update Date | 04/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003944620 | NPI | - | NPPES |
| 936315701 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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