Modern Mojo
Clinic/Center, Mental Health (Including Community Mental Health Center) in Grand Rapids, MN. Organization (NPI-2).
NPI number1902344591
StatusActive
Last updated in NPPESMar 8, 2023
Details
- NPI
- 1902344591
- Entity type
- Organization (NPI-2)
- Legal business name
- Modern Mojo
- Organization subpart
- No
- Enumeration date
- Feb 3, 2017
- Certification date
- Mar 8, 2023
- Last updated
- Mar 8, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
28 Nw 4th StSuite A
Grand Rapids, MN 55744-2714
Phone 218-999-7750
Mailing address
28 Nw 4th StSuite A
Grand Rapids, MN 55744-2714
Phone 218-999-7750
Other practice locations
1708 1st St S
Willmar, MN 56201-4228
Willmar, MN 56201-4228
Phone 218-999-7750 · Fax 218-999-9461
Authorized official
Tonya Marie Zimmerman
Office Manager
2189997750
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