Organization
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Active
Other names
Humboldt Jr Sr HighSchool Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
REUBEN MOORE (CEO)
(651) 602-7500
Entity
Organization
Contact information
Practice address
30 BAKER ST E, SAINT PAUL, MN 55107-2966
(651) 312-1996
(651) 312-1997
Mailing address
153 CESAR CHAVEZ ST, SAINT PAUL, MN 55107-2226
(651) 602-7500
(651) 602-7513
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
522927000
—
MN
Enumeration date
03/16/2007
Last updated
05/15/2024
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