Theresas Home LLC
NPI #1457022501 in South Saint Paul, Minnesota
Provider Information
- NPI Number
- 1457022501
- Entity Type
- Organization
- Organization Name
- Theresas Home LLC
- Primary Specialty
- Community Based Residential Treatment Facility, Mental Illness
- Enumeration Date
- Sep 27, 2021
- Last Updated
- Sep 27, 2021
Practice Location
- Address
- 224 2ND AVE S
- City
- South Saint Paul
- State
- Minnesota
- ZIP Code
- 55075-2346
- Phone
- (763) 291-4288
Authorized Official
- Name
- DR. VIVIAN NGONGANG OGUNYEMI, DNP
- Title
- CEO
- Phone
- (763) 291-4288
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Mental Illness |
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