Organization
WILD RIVER SERVICES INC
Active
Other names
The Haven
Organization subpart
No
Provider details
NPI number
Authorized official
COLIN KELLY FAULKNER (EXECUTIVE DIRECTOR)
(651) 558-9522
Entity
Organization
Contact information
Practice address
1394 JACKSON ST STE 220, SAINT PAUL, MN 55117-4631
(651) 558-9522
Mailing address
1394 JACKSON ST STE 220, SAINT PAUL, MN 55117-4631
(651) 558-9522
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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