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Organization
MSOCS-CHATHAM
Active
Organization
MSOCS-CHATHAM
Active
Parent organization
EASTERN MINNESOTA STATE OPERATED COMMUNITY SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
EASTERN MINNESOTA STATE OPERATED COMMUNITY SERVICES
Authorized official
ROGER A DENEEN (RESIDENTIAL PROG SVCS DIRECTOR)
(651) 582-1857
Entity
Organization
Contact information
Practice address
6204 CHATHAM WAY, EDEN PRAIRIE, MN 55346-1307
(952) 934-0995
Mailing address
PO BOX 64979, SAINT PAUL, MN 55164-0979
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064245200
—
MN
Enumeration date
11/16/2006
Last updated
06/18/2008
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