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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