Theodore I

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

802493-1-RMI Issued in MN

Legal business name

THEODORE I

Practice address

1314 Livingston Ave
Saint Paul, MN 55118-2409

Phone

(651) 501-2378

Fax

(651) 738-1737

NPI assigned

Dec 26, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Michele K. Boston

Title

Ceo

Phone

(651) 501-2378

Specialties & licenses 1

Addresses

Other names 1

• Boston Health Care Systems, Inc. Former legal business name

Tax ID family

Boston Health Care Systems Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Boston Health Care Systems, Inc.

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1174688741
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sherry L. Fridlund, MALP

  • Mental Health Counselor
  • Edina, MN
  • NPI 1891912267
  NPD (past)

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831254408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1865 OLD HUDSON RD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551194308",
            "telephone_number": "651-501-2378",
            "fax_number": "651-738-1737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 LIVINGSTON AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551182409",
            "telephone_number": "651-501-2378",
            "fax_number": "651-738-1737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE I",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOSTON",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "651-501-2378",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MN",
            "license": "802493-1-RMI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boston Health Care Systems, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kasey Ann Theisen Sturm, M.D.
• Andrea Marie Thelen, B.S, M.A.
• Sandra Lynn Thelen, ATC
• Rudy G Thell, MD
• Geoffrey J Theobald, P.A.-C
• Dean Theodore Theophilos, LPCC, LCPC, LADC
• Bane Theppalad, PCA
• Lane Theppalad
• Therapeace Counseling, LLC
• Therapeuo Mental Health

• Mental Illness Community Based Residential Treatment Facility in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Mental Illness Community Based Residential Treatment Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.