| Organization Name: | WEST SIDE COMMUNITY HEALTH SERVICES, INC. |
| NPI Number: | 1013100809 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MAVIS CAROL BREHM (EXECUTIVE DIRECTOR) |
| Mailing Address: | 381 Robie St E Saint Paul |
| State: | MN US |
| Postal Code: | 551072415 |
| Phone Number: | 6516027976 |
| Fax Number: | 6516027977 |
| NPI Enumeration Date: | 08/24/2007 |
| NPI Last Update Date: | 06/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |