1760867501 NPI number — UPLINK STAFFING INC

Table of content: (NPI 1760867501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760867501 NPI number — UPLINK STAFFING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPLINK STAFFING 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:
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:
1760867501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 BROOKLYN BLVD
Provider Second Line Business Mailing Address:
208
Provider Business Mailing Address City Name:
BROOKLYN CENTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55429-2517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-971-8888
Provider Business Mailing Address Fax Number:
763-971-8892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5901 BROOKLYN BLVD
Provider Second Line Business Practice Location Address:
208
Provider Business Practice Location Address City Name:
BROOKLYN CENTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55429-2517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-971-8888
Provider Business Practice Location Address Fax Number:
763-971-8892
Provider Enumeration Date:
07/22/2015

Additional Information

Authorized Official

Authorized Official Last Name:
AMAYANVBO
Authorized Official First Name:
LOVETH
Authorized Official Middle Name:
O
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
763-971-8888

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  372896 , 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)

  • Identifier: 372896 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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