Organization
12TH HOUSE HEALING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAYONNA MARTIA MAYS RN (CEO)
(612) 584-0902
Entity
Organization
Contact information
Practice address
650 AGUIRRE ST APT 232, SAINT PAUL, MN 55130-4430
(612) 584-0902
Mailing address
650 AGUIRRE ST APT 232, SAINT PAUL, MN 55130-4430
(612) 584-0902
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
—
—
251J00000X
Nursing Care Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
11/10/2023
Last updated
11/10/2023
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