Organization
MY HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FARRIS L. GLOVER LADC (EXECUTIVE DIRECTOR)
(651) 659-0359
Entity
Organization
Contact information
Practice address
420 N 5TH ST, SUITE 949, MINNEAPOLIS, MN 55401-1348
(612) 343-0661
(612) 341-8353
Mailing address
1010 UNIVERSITY AVE W, SUITE 1, SAINT PAUL, MN 55104-4746
(651) 659-0359
(651) 645-1688
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1015883-1-CDT
MN
Other
Enumeration date
09/20/2006
Last updated
08/22/2020
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