1962725358 NPI number — MORRIS HEALTH SERVICES

Table of content: (NPI 1962725358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962725358 NPI number — MORRIS HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRIS HEALTH SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SKYVIEW COURT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962725358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 NEVADA AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56267-1874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-589-2004
Provider Business Mailing Address Fax Number:
320-589-2543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 COURT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-589-0245
Provider Business Practice Location Address Fax Number:
320-589-3929
Provider Enumeration Date:
03/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MONCRIEF
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
320-589-4910

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  369819 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 344620 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 030701078 . This is a "PRIMEWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 913855200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: A774672100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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