NPIMap

Organization Active NPI

South Metro Human Services

  • Mental Illness Community Based Residential Treatment Facility
  • Maplewood, MN
National Provider Identifier
1598853533
Registry record updated May 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
801654-1-RMI Issued in MN
Legal business name
SOUTH METRO HUMAN SERVICES
Practice address
1096 Gervais Ave
Maplewood, MN 55109-1909
Phone
(651) 221-9880
Fax
(651) 225-1545
NPI assigned
Oct 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2015

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

Authorized official

Name
Tom Paul
Title
President
Phone
(651) 256-1234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 801654-1-RMI MN Primary

Addresses

Primary practice location

1096 Gervais Ave
Maplewood, MN 55109-1909

Mailing address

1096 Gervis Ave
Maplewood, MN 55109
Phone (651) 221-9880

Other identifiers 1

IdentifierTypeStateIssuer
355499600MedicaidMN

Other names 1

  • Community Foundations Other name

National Provider Directory

National Provider Directory
Tax ID family
South Metro Human Services-Act Blue20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Locations

1096 Gervais Ave
Maplewood, MN 55109
Phone (651) 221-9880

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432166400000",
    "number": "1598853533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1096 GERVIS AVE",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "55109",
            "telephone_number": "651-221-9880",
            "fax_number": "651-225-1545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1096 GERVAIS AVE",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091909",
            "telephone_number": "651-221-9880",
            "fax_number": "651-225-1545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH METRO HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2015-05-21",
        "status": "A",
        "authorized_official_last_name": "PAUL",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-256-1234"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MN",
            "license": "801654-1-RMI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "355499600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Foundations",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Maplewood, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; 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.