1396993036 NPI number — CHRISTINE PROFESSIONAL HEALTH CARE INC

Table of content: (NPI 1396993036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396993036 NPI number — CHRISTINE PROFESSIONAL HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTINE PROFESSIONAL HEALTH CARE 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:
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:
1396993036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9970 MADISON ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAINE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55434-4207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-464-4072
Provider Business Mailing Address Fax Number:
763-784-9322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9970 MADISON ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAINE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55434-4207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-464-4072
Provider Business Practice Location Address Fax Number:
763-784-9322
Provider Enumeration Date:
09/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OHENZUWA
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
OSARO
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
763-464-4072

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  HE0108404 , 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: A185457000 . This is a "UMPI MINNESOTA HEALTH CARE PROGRAM MHCP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: A265455100 . This is a "UMPI MINNESOTA HEALTH CARE PROGRAM MHCP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: A936637200 . This is a "UMPI MINNESOTA HEALTH CARE PROGRAM MHCP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: A562678200 . This is a "UMPI MINNESOTA HEALTH CARE PROGRAMS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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