Organization
DIVERSE HEALTH AND SOCIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
XENG YING PHA LICSW (CO-OWNER)
(651) 425-1614
Entity
Organization
Contact information
Practice address
9216 WHITE OAKS TRL, CHAMPLIN, MN 55316-2675
(651) 425-1614
Mailing address
9216 WHITE OAKS TRL, CHAMPLIN, MN 55316-2675
(651) 425-1614
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
251B00000X
Case Management Agency
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
311ZA0620X
Adult Care Home Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
05/24/2024
Last updated
05/24/2024
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