Southside Life Care Center

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

SOUTHSIDE LIFE CARE CENTER

Practice address

4105 Chicago Ave
Minneapolis, MN 55407-3144

Phone

(612) 823-0301

Fax

(612) 823-0775

NPI assigned

Apr 23, 2008

Organization subpart

No

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

Authorized official

Name

Kimberly Rynders

Title

Executive Director

Phone

(612) 823-0301

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208908800000",
    "number": "1982879771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4105 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073144",
            "telephone_number": "612-823-0301",
            "fax_number": "612-823-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073144",
            "telephone_number": "612-823-0301",
            "fax_number": "612-823-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE LIFE CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2008-04-23",
        "status": "A",
        "authorized_official_last_name": "RYNDERS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-823-0301"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southside Community Health Services, Inc. (Southside East Lake Street Dental Clinic)
• Southside Community Health Services, Inc.
• Southside Community Health Services, Inc.
• Southside Community Health Services, Inc.
• Southside Family Charter School
• Southside Medical Clinic at the Adler Center
• Southside Midwifery Collective Inc
• Southside Transportation LLC
• Bronwyn Southwell, M.D.
• Southwest Family Serivces

• Voluntary or Charitable Agency in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Voluntary or Charitable Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.