Healthcare Provider Details

I. General information

NPI: 1366984536
Provider Name (Legal Business Name): ALLIED HEALTH CARE PROFESSIONAL SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2016
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W CLARK ST
ALBERT LEA MN
56007
US

IV. Provider business mailing address

140 W CLARK ST
ALBERT LEA MN
56007-2546
US

V. Phone/Fax

Practice location:
  • Phone: 507-668-4024
  • Fax: 507-668-4023
Mailing address:
  • Phone: 507-668-4024
  • Fax: 507-668-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number379183
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number141067-3
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number141067-3
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number141067-3
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number141067-3
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number141067-3
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number141067-3
License Number StateMN
# 8
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number141067-3
License Number StateMN
# 9
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number141067-3
License Number StateMN
# 10
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number141067-3
License Number StateMN
# 11
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 12
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number141067-3
License Number StateMN
# 13
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number141067-3
License Number StateMN
# 14
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number141067-3
License Number StateMN
# 15
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number141067-3
License Number StateMN

VIII. Authorized Official

Name: VICTORIA KAREN MCGILL
Title or Position: ADMINISTRATOR-CEO
Credential: REGISTERED NURSE
Phone: 507-383-3517