1366575714 NPI number — OAKDALE HEALTH ENTERPRISES INC

Table of content: (NPI 1366575714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366575714 NPI number — OAKDALE HEALTH ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKDALE HEALTH ENTERPRISES INC
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:
OAKDALE ENTERPRISES NORTH AMBULANCE PARK RAPIDS
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:
1366575714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/13/2008
NPI Reactivation Date:
03/20/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 68TH AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN CENTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55429-1712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-520-4319
Provider Business Mailing Address Fax Number:
763-520-4829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 HATCH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56470-4302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-520-4319
Provider Business Practice Location Address Fax Number:
763-520-4829
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALBRIGHT
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM CFO
Authorized Official Telephone Number:
763-581-4768

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 109971 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203675400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82395JO . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 590015507 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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