Organization
TAPESTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CONNIE BOMBENGER LADC (DIRECTOR)
(651) 489-7740
Entity
Organization
Contact information
Practice address
135 COLORADO ST E, SAINT PAUL, MN 55107-2244
(651) 454-2323
Mailing address
135 COLORADO ST E, SAINT PAUL, MN 55107-2244
(651) 454-2323
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
301767
MN
Other
Enumeration date
04/20/2011
Last updated
04/20/2011
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