Organization
ON CALL CLINICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDY GOLDETSKY CEO (CEO)
(763) 544-1000
Entity
Organization
Contact information
Practice address
5861 CEDAR LAKE RD S, ST LOUIS PARK, MN 55416-1653
(763) 544-1000
Mailing address
10721 SMETANA RD APT 206, MINNETONKA, MN 55343-8081
(952) 994-3619
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
1700217296
MN
Other
Enumeration date
09/19/2014
Last updated
09/19/2014
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