TUBMAN (NPI# 1295866911) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295866911 |
| Entity Type | Organization |
| Organization Name | TUBMAN |
| Other Organization Name | CHRYSALIS |
| Practice Address |
4432 Chicago Ave S Minneapolis MN 55407-3519 |
| Practice Telephone | 6128702444 |
| Practice Fax Number | 6128702428 |
| Mailing Telephone | 6128702444 |
| Mailing Fax Number | 6128702428 |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2008-11-12 |
| Authorized Official Name | BEVERLY DUSSO (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6127676690 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
800488-3-CDT | MN | Ambulatory Health Care Facilities |
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
800487-2-MCH | MN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 257080700 | 05 | |
| MN | 575255800 | 05 | |
| MN | BCBS | 9026CH | 01 |
| Other Name | Type Code |
|---|---|
| Chrysalis | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376655159 | Tubman | Clinic/Center | 4432 Chicago Avenue South, Minneapolis, MN 55407 | 2006-08-31 |
| 1730490665 | Tubman | Community/Behavioral Health | 4432 Chicago Ave, Minneapolis, MN 55407-3519 | 2010-06-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | TUBMAN CENTER FOR HEALTH & FREEDOM | 3518 S Edmunds St, Seattle, WA 98118-1727 |
| New York State Corporations | TUBMAN CONTRACTING, INC. | 137-06 220th Street, Laurelton, Ny 11413 |
| Colorado Business Entities | Tubman Hilliard Global Academy | 929 29th St., Denver, CO 80205 |
| System for Award Management (SAM) Entities | TUBMAN HOLDINGS, LLC | 2642 Da Vinci Blvd, Decatur, GA 30034-3100 |
| Massachusetts Corporations | TUBMAN INVESTMENT CORP. | 11 Neck Pond Road, Osterville, MA 02655 |
| Oregon Corporations, Companies and Business Names | TUBMAN PROPERTIES, LLC | 62696 Nw Imbler Ct, Bend, OR 97703 |
| System for Award Management (SAM) Entities | TUBMAN TOWERS | 17 W Johnson Ave, Springfield, OH 45506-3553 |
| Street Address |
4432 CHICAGO AVE S |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55407-3519 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720644057 | Amana Home Care | Home Health | 2833 13th Ave S Suite 118, Minneapolis, MN 55407 | 2019-05-13 |
| 1356802979 | Aaron Randy Pickrel | Student in an Organized Health Care Education/Training Program | 2800 Chicago Avenue, #250, Minneapolis, MN 55407 | 2019-03-27 |
| 1053881631 | Naimo Abdisalam | Registered Nurse | 1229 East Lake Street, Minneapolis, MN 55407 | 2018-11-27 |
| 1437639614 | Kelly Usitalo | Nurse Practitioner | 913 E 26th Street, Piper Building Suite 401, Minneapolis, MN 55407 | 2018-08-17 |
| 1952880346 | Allison Hall | Internal Medicine | Minneapolis Heart Institute, 920 E 28 St. #300, Minneapolis, MN 55407 | 2018-08-07 |
| 1780176370 | Rebekah Sand | Physical Therapist | 2800 Chicage Avenue S, Suite 102, Minneapolis, MN 55407 | 2018-05-31 |
| 1417448663 | Vivian T.c. Liu | Student in an Organized Health Care Education/Training Program | 2020 E 28th Street, Suite 104, Minneapolis, MN 55407 | 2018-05-23 |
| 1053802397 | Isuroon | Counselor | 1600 East Lake Street Suite 1, Minneapolis, Mpls, MN 55407 | 2018-05-22 |
| 1154811404 | Mohamed Mukhtar Ali | Dentist | 4700 Cedar Ave S, Minneapolis, MN 55407 | 2018-05-12 |
| 1396254280 | Erin Elizabeth Casper | Registered Nurse | 3621 Oakland Ave, Minneapolis, MN 55407 | 2017-09-25 |
| Find all providers in zip 55407 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205433984 | Hopebridge Life Skills Center | Clinic/Center | 3617 E Lake St, Minneapolis, MN 55406-2148 | 2020-10-05 |
| 1801404637 | Golden Health LLC | Clinic/Center | 3601 Phillips Pkwy Apt 116, Minneapolis, MN 55426-3800 | 2020-07-17 |
| 1720562812 | Axisspoint Inc | Clinic/Center | 2021 E Hennepin Ave Ste 193, Minneapolis, MN 55413-1773 | 2018-09-24 |
| 1295213759 | Kathleen Healthcare Center | Clinic/Center | 2647 Bloomington Ave, Minneapolis, MN 55407-1187 | 2018-08-06 |
| 1730672106 | Koru Holistic Counseling | Clinic/Center | 314 Clifton Ave Ste 10, Minneapolis, MN 55403-3384 | 2018-06-11 |
| 1043700800 | Roots Therapy & Consulting LLC | Clinic/Center | 2920 Bryant Ave S Ste 112, Minneapolis, MN 55408-2332 | 2018-05-16 |
| 1093216848 | Cure Care Psychotherapy LLC | Clinic/Center | 730 E 38th St Ste 201, Minneapolis, MN 55407-5235 | 2018-02-27 |
| 1801308077 | Nicole J Wolf Phd Lp | Clinic/Center | 4749 Chicago Ave Ste 1a, Minneapolis, MN 55407-4181 | 2017-10-27 |
| 1386953974 | Water's Edge Psychotherapy, LLC | Clinic/Center | 3617 45th Ave S, Minneapolis, MN 55406-2928 | 2010-09-29 |
| 1992934392 | Morningsong Therapy Center Inc | Clinic/Center | 25 W. Diamond Lake Road, Minneapolis, MN 55419 | 2009-07-07 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55407 |
Please comment or provide details below to improve the information on TUBMAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.