NPIMap

Organization Active NPI

Wild River Services Inc

  • Adult Day Care Clinic/Center
  • Saint Paul, MN
National Provider Identifier
1962013847
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
Legal business name
WILD RIVER SERVICES INC
Doing business as
The Haven
Practice address
1394 Jackson St Ste 220
Saint Paul, MN 55117-4631
Phone
(651) 558-9522
NPI assigned
Aug 13, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Authorized official

Name
Colin Kelly Faulkner
Title
Executive Director
Phone
(651) 558-9522

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X Primary

Addresses

Primary practice location

1394 Jackson St Ste 220
Saint Paul, MN 55117-4631

Mailing address

1394 Jackson St Ste 220
Saint Paul, MN 55117-4631
Phone (651) 558-9522

Other names 1

  • The Haven Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wild River Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1394 Jackson St
Ste 220
Saint Paul, MN 55117
Phone (651) 558-9522

NPI Registry JSON

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

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1962013847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1394 JACKSON ST STE 220",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551174631",
            "telephone_number": "651-558-9522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1394 JACKSON ST STE 220",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551174631",
            "telephone_number": "651-558-9522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD RIVER SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-13",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "COLIN",
        "authorized_official_middle_name": "KELLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-558-9522"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Haven",
            "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 Aug 13, 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.