1962757617 NPI number — ARUBAH EMOTIONAL HEALTH SERVICES PA

Table of content: (NPI 1962757617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962757617 NPI number — ARUBAH EMOTIONAL HEALTH SERVICES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARUBAH EMOTIONAL HEALTH SERVICES PA
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:
1962757617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 COUNTY ROAD 10
Provider Second Line Business Mailing Address:
STE 204B
Provider Business Mailing Address City Name:
BROOKLYN CENTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55429-3072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-447-5573
Provider Business Mailing Address Fax Number:
763-273-8892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 COUNTY ROAD 10
Provider Second Line Business Practice Location Address:
STE 204B
Provider Business Practice Location Address City Name:
BROOKLYN CENTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55429-3072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-447-5573
Provider Business Practice Location Address Fax Number:
763-273-8892
Provider Enumeration Date:
07/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KEYES
Authorized Official First Name:
ANISSA
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
763-447-5573

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  2538 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 2538 , 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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