Organization
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Active
Organization
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Active
Other names
Agape Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
REUBEN MOORE (EXECUTIVE DIRECTOR)
(651) 602-7500
Entity
Organization
Contact information
Practice address
1037 UNIVERSITY AVE W, SAINT PAUL, MN 55104-4788
(651) 602-7500
(651) 602-7513
Mailing address
153 CESAR CHAVEZ ST, SAINT PAUL, MN 55107-2226
(651) 222-1816
(651) 222-1305
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103124
UCARE
MN
05
—
724657100
—
MN
Enumeration date
03/16/2007
Last updated
05/15/2024
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