FAMILY REVELATIONS INC. (NPI# 1790212926) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790212926 |
| Entity Type | Organization |
| Organization Name | FAMILY REVELATIONS INC. |
| Practice Address |
1705 Cope Ave E Ste I Maplewood MN 55109-2639 |
| Practice Telephone | 6513196484 |
| Practice Fax Number | 6519250442 |
| Mailing Telephone | 6513196484 |
| Mailing Fax Number | 6519250442 |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2019-06-11 |
| Authorized Official Name | BERNIE JEROME MENGE (OWNER / PARTNER) |
| Authorized Official Telephone | 6513196484 |
| Authorized Official Credential | MA. LMFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YP2500X |
Counselor Specialization: Professional |
3335 | MO | Behavioral Health & Social Service Providers |
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
3335 | MN | Ambulatory Health Care Facilities |
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
MN | Ambulatory Health Care Facilities | |
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
3335 | MN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 1134490469 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1303 S Frontage Rd Ste 275, Hastings, MN 550332655 | 6513196484 | 6519250442 |
| Street Address |
1705 COPE AVE E STE I |
| City | MAPLEWOOD |
| State | MN |
| Zip Code | 55109-2639 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326458340 | Chong Chang | Counselor | 1705 Cope Ave E Ste I, Maplewood, MN 55109 | 2014-04-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366063828 | Jodi May Begordis | Registered Nurse | 2586 7th Ave East, Suite 302, North St Paul, MN 55109 | 2020-05-06 |
| 1467917146 | Alejandro Diez Freire | Social Worker | 2468 Germain St, Maplewood, MN 55109 | 2019-02-06 |
| 1679099667 | Rochelle Marie Clarke | Registered Nurse | 2586 7th Ave East Suite 302, North Saint Paul, MN 55109 | 2017-08-21 |
| 1497298210 | Salams Care Residential, LLC | Home Health | 2240 Ide Ct, Maplewood, MN 55109 | 2016-11-28 |
| 1093199630 | Garry Allen | Psychologist | 2345 Ariel St North Mail Stop 13601a, Maplewood, MN 55109 | 2015-07-14 |
| 1700264751 | Matthew Seng Thao | Student in an Organized Health Care Education/Training Program | 1470 Gervais Ave, Maplewood, MN 55109 | 2015-05-11 |
| 1619396488 | Leah Anne Downey | Occupational Therapist | 2399 Ariel St. N., Children's Theraplay, LLC, Maplewood, MN 55109 | 2014-04-09 |
| 1356765440 | Group Health Plan, Inc | Clinic/Center | 2520 12th Ave E, North St Paul, MN 55109 | 2014-02-10 |
| 1336560275 | Veneman Dental Care, Pa | Dentist | 1774 Cope Ave, Suite 110, Maplewood, MN 55109 | 2013-12-19 |
| 1104173723 | Coventry Senior Living of Maplewood, LLC | Home Health | 1870 East Shore Drive, Maplewood, MN 55109 | 2012-08-14 |
| Find all providers in zip 55109 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
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| 1295156065 | Synapse Behavioral Medicine LLC | Clinic/Center | 2010 Springfield Ave, Maplewood, NJ 07040-3437 | 2013-12-22 |
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| 1780207829 | Amazing You Therapy, LLC | Clinic/Center | 421 1st Ave Sw Ste 300w, Rochester, MN 55902-3389 | 2020-05-23 |
| 1609499813 | Bright Place LLC | Clinic/Center | 3835 Bakken Blvd, Columbia Heights, MN 55421-5056 | 2020-05-21 |
| 1568082428 | Cloud Home Health Care Services LLC | Clinic/Center | 22 Wilson Ave Ne Ste 208, Saint Cloud, MN 56304-0440 | 2020-04-21 |
| 1235763814 | Monarch Wellness LLC | Clinic/Center | 51 E 4th St Ste 309, Winona, MN 55987-3791 | 2020-02-23 |
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| 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.