1689217747 NPI number — TRUE NORTH HEALTH NAVIGATION LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689217747 NPI number — TRUE NORTH HEALTH NAVIGATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUE NORTH HEALTH NAVIGATION 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:
1689217747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3455 RINGSBY CT STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80216-4923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
970 LAKE CARILLON DR STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33716-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-500-1518
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
CHIEF CLINICAL OFFICER
Authorized Official Telephone Number:
614-226-4921

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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