Organization
INSTITUTE FOR MINORITY DEV
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLA MAE GROSS (EX DIRECTOR)
(763) 566-4251
Entity
Organization
Contact information
Practice address
3608 78TH AVE NO, BROOKLYN PARK, MN 55443
(763) 566-4251
(763) 566-3049
Mailing address
3608 78TH AVE NO, BROOKLYN PARK, MN 55443
(763) 566-4251
(763) 566-3049
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
074522700
MN
251S00000X
Community/Behavioral Health Agency
805936-5-WS
MN
251S00000X
Community/Behavioral Health Agency
Primary
831150-3-SILS
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127812600
—
MN
Enumeration date
02/15/2007
Last updated
10/16/2008
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