1629361092 NPI number — VALLEY SENIOR SERVICES ALLIANCE

Table of content: (NPI 1629361092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629361092 NPI number — VALLEY SENIOR SERVICES ALLIANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY SENIOR SERVICES ALLIANCE
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:
6
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:
1629361092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2845 HAMLINE AVE NORTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-631-6187
Provider Business Mailing Address Fax Number:
651-631-6122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5610 NORWICH PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK PARK HEIGHTS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
851-275-5801
Provider Business Practice Location Address Fax Number:
651-275-5802
Provider Enumeration Date:
05/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CONWAY
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR OF CREATIVE INDE
Authorized Official Telephone Number:
651-631-6123

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  1064266-1-ADC , 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)





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