1932521838 NPI number — PROMISE COMPREHENSIVE SERVICES, INC.

Table of content: (NPI 1932521838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932521838 NPI number — PROMISE COMPREHENSIVE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROMISE COMPREHENSIVE SERVICES, 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:
CARE PLUS HOME CARE
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:
1932521838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7655 61ST ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTTAGE GROVE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55016-6004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-236-7979
Provider Business Mailing Address Fax Number:
651-714-9213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
393 DUNLAP ST N STE 400A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55104-4235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-739-6933
Provider Business Practice Location Address Fax Number:
651-714-9213
Provider Enumeration Date:
01/10/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALI USMANU
Authorized Official First Name:
RIH-REH
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM MANAGER
Authorized Official Telephone Number:
612-236-7979

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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