Organization
ALLY SUPPORTIVE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN TONNANCOUR (CHIEF MANAGER)
(651) 302-4471
Entity
Organization
Contact information
Practice address
245 MARIE AVE E STE 107, WEST ST PAUL, MN 55118-4280
(651) 302-4471
Mailing address
PO BOX 544, SOUTH ST PAUL, MN 55075-0544
(651) 302-4471
(651) 760-4334
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A720082300
STATE OF MINNESOTA
MN
Enumeration date
02/17/2021
Last updated
02/17/2021
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