Organization
OUR HOUSE OF MINNESOTA, INC. I
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS HOLMAN (ADMINISTRATOR)
(651) 646-1104
Entity
Organization
Contact information
Practice address
1846 DAYTON AVE, SAINT PAUL, MN 55104-6012
(651) 644-6650
(651) 644-6650
Mailing address
1846 PORTLAND AVE, SAINT PAUL, MN 55104-6062
(651) 646-1104
(651) 646-1104
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
801828-1-RS
MN
Other
Enumeration date
10/27/2006
Last updated
08/22/2020
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