NPIMap

Organization Active NPI

Professional Resource Network, Inc

  • Community/Behavioral Health Agency
  • Saint Paul, MN
National Provider Identifier
1447685235
Registry record updated Sep 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PROFESSIONAL RESOURCE NETWORK, INC
Practice address
1 Water St W
Suite 255
Saint Paul, MN 55107-2002
Phone
(952) 858-8807
NPI assigned
Sep 11, 2013
Organization subpart
Yes
Parent organization
PROFESSIONAL RESOURCE NETWORK, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 11, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Charie L Devolites
Title
Ceo
Phone
(952) 858-8807

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1 Water St W
Suite 255
Saint Paul, MN 55107-2002

Mailing address

2740 American Blvd W
Suite 100
Bloomington, MN 55431-1203
Phone (952) 858-8807

Other identifiers 1

IdentifierTypeStateIssuer
11727900MedicaidMN

Other names 1

  • Professional Resource Network Behavioral Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Professional Resource Network Inc3 organizations share this tax ID, including this one
Part of
Professional Resource Network Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1 Water St W
Ste 255
Saint Paul, MN 55107
Phone (952) 858-8807

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378857600000",
    "number": "1447685235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 AMERICAN BLVD W",
            "address_2": "SUITE 100",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311203",
            "telephone_number": "952-858-8807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WATER ST W",
            "address_2": "SUITE 255",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551072002",
            "telephone_number": "952-858-8807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL RESOURCE NETWORK, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROFESSIONAL RESOURCE NETWORK, INC",
        "enumeration_date": "2013-09-11",
        "last_updated": "2013-09-11",
        "status": "A",
        "authorized_official_last_name": "DEVOLITES",
        "authorized_official_first_name": "CHARIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "952-858-8807"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11727900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Resource Network Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.