1013157288 NPI number — INTEGRATED HEALTHCARE SERVICES GOLDEN VALLEY PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013157288 NPI number — INTEGRATED HEALTHCARE SERVICES GOLDEN VALLEY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HEALTHCARE SERVICES GOLDEN VALLEY PA
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:
Provider Other Organization Name Type Code:
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:
1013157288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6480 WAYZATA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55426-1710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-593-0919
Provider Business Mailing Address Fax Number:
763-593-9556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 TWELVE OAKS CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WAYZATA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55391-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-893-8900
Provider Business Practice Location Address Fax Number:
952-893-7399
Provider Enumeration Date:
03/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MASSOGLIA
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
763-593-0919

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  618 , 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)





Copyright © 2007-2024 www.npivalidator.com