1861834889 NPI number — BUURTZORG MINNESOTA LLC

Table of content: (NPI 1861834889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861834889 NPI number — BUURTZORG MINNESOTA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUURTZORG MINNESOTA 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:
BUURTZORG MINNESOTA
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:
1861834889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
972 INSPIRATION PKWY N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYPORT
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55003-1613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-605-1400
Provider Business Mailing Address Fax Number:
651-689-8840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
972 INSPIRATION PKWY N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYPORT
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55003-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-605-1400
Provider Business Practice Location Address Fax Number:
651-689-8840
Provider Enumeration Date:
07/18/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MICHELS
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
MUENICH
Authorized Official Title or Position:
PRESIDENT, CEO
Authorized Official Telephone Number:
651-605-1400

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  29716 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: 29716 , 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)