Organization
AMHERST H. WILDER FOUNDATION
Active
Other names
Bush Evening Treatment
Organization subpart
No
Provider details
NPI number
Authorized official
MORRIS GOODWIN (CHIEF ADMINISTRATIVE DIRECTOR)
(651) 280-2000
Entity
Organization
Contact information
Practice address
451 LEXINGTON PKWY N, SAINT PAUL, MN 55104-4636
(651) 280-2000
(651) 280-3995
Mailing address
451 LEXINGTON PKWY N, SAINT PAUL, MN 55104-4636
(651) 280-2000
(651) 280-3995
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
555055600
MEDICAL ASSISTANCE
MN
Enumeration date
10/29/2008
Last updated
10/29/2008
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