Institute for Minority Dev

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

831150-3-SILS Issued in MN

Legal business name

INSTITUTE FOR MINORITY DEV

Practice address

3608 78TH Ave No
Brooklyn Park, MN 55443

Phone

(763) 566-4251

Fax

(763) 566-3049

NPI assigned

Feb 15, 2007

Organization subpart

No

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

Authorized official

Name

Ella Mae Gross

Title

Ex Director

Phone

(763) 566-4251

Specialties & licenses 3

Addresses

Other identifiers 1

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1508909730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3608 78TH AVE NO",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "55443",
            "telephone_number": "763-566-4251",
            "fax_number": "763-566-3049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3608 78TH AVE NO",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "55443",
            "telephone_number": "763-566-4251",
            "fax_number": "763-566-3049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE FOR MINORITY DEV",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "ELLA",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "EX DIRECTOR",
        "authorized_official_telephone_number": "763-566-4251"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "805936-5-WS",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "831150-3-SILS",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "074522700",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127812600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Brooklyn Park, MN
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; 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.