Organization
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Active
Other names
Highland Park Jr/SR HS Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
REUBEN MOORE (CEO)
(651) 602-7500
Entity
Organization
Contact information
Practice address
1015 SNELLING AVE S, SAINT PAUL, MN 55116-2447
(651) 690-7667
(651) 690-7670
Mailing address
153 CESAR CHAVEZ ST, SAINT PAUL, MN 55107-2226
(651) 602-7500
(651) 602-7513
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103124
UCARE
MN
05
—
302663000
—
MN
Enumeration date
08/21/2007
Last updated
05/15/2024
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