Provider Demographics
NPI:1538195912
Name:NORTH MEMORIAL HEALTH CARE
Entity type:Organization
Organization Name:NORTH MEMORIAL HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-581-4635
Mailing Address - Street 1:4501 68TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1712
Mailing Address - Country:US
Mailing Address - Phone:763-581-4674
Mailing Address - Fax:763-581-4561
Practice Address - Street 1:4501 68TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1712
Practice Address - Country:US
Practice Address - Phone:763-581-4674
Practice Address - Fax:763-581-4561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH MEMORIAL HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-25
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN496517500Medicaid
5014478OtherMEDICA
957OtherHEALTH PARTNERS
957OtherHEALTH PARTNERS