Organization
POWER OF RELATIONSHIPS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES W KEENAN MS, LP (PRESIDENT, EXECUTIVE DIRECTOR)
(612) 221-2441
Entity
Organization
Contact information
Practice address
820 LILAC DR N, SUITE 130, GOLDEN VALLEY, MN 55422-4700
(612) 874-6746
(612) 874-6745
Mailing address
14329 ALLEN DR, SAVAGE, MN 55378-2230
(612) 221-2441
(612) 874-6745
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
LP3544
MN
251S00000X
Community/Behavioral Health Agency
LP3544
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136560
UCARE-MN
MN
01
—
136564
UCARE-MN IND NUMBER
MN
01
—
26A03PO
BLUE CROSS GROUP NMBER
MN
05
—
446316100
—
MN
05
—
446316101
—
MN
01
—
45291
HEALTH PARTNERS
MN
01
—
84-63537
MEDICA
MN
01
—
990223002
MHP
MN
Enumeration date
12/14/2006
Last updated
07/14/2008
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