Organization
AMHERST H. WILDER FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MORRIS GOODWIN (VICE PRESIDENT ADMINISTRATION)
(651) 280-2310
Entity
Organization
Contact information
Practice address
451 LEXINGTON PKWY N, SAINT PAUL, MN 55104-4636
(651) 280-2000
(651) 280-2310
Mailing address
451 LEXINGTON PKWY N, SAINT PAUL, MN 55104-4636
(651) 280-2310
(651) 280-3995
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
555055600
MEDICAL ASSISTANCE
MN
Enumeration date
11/29/2006
Last updated
10/03/2012
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