1821765306 NPI number — CORTEX REHABILITATION LLC

Table of content: (NPI 1821765306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821765306 NPI number — CORTEX REHABILITATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORTEX REHABILITATION LLC
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:
1821765306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6620 MEADOWLARK LN N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE GROVE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55369-6043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-380-1237
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11658 FOUNTAINS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE GROVE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55369-7195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-284-1970
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUEFFERT
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
605-380-1237

Provider Taxonomy Codes

  • Taxonomy code: 2251N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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