Organization
THERESAS HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIVIAN NGONGANG OGUNYEMI DNP (CEO)
(763) 291-4288
Entity
Organization
Contact information
Practice address
224 2ND AVE S, SOUTH SAINT PAUL, MN 55075-2346
(763) 291-4288
Mailing address
9985 AUSTIN ST NE, CIRCLE PINES, MN 55014-2412
(763) 291-4288
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/27/2021
Last updated
09/27/2021
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