Healthcare Provider Details

I. General information

NPI: 1538195912
Provider Name (Legal Business Name): NORTH MEMORIAL HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 68TH AVE N
BROOKLYN CENTER MN
55429-1712
US

IV. Provider business mailing address

4501 68TH AVE N
BROOKLYN CENTER MN
55429-1712
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-4674
  • Fax: 763-581-4561
Mailing address:
  • Phone: 763-581-4674
  • Fax: 763-581-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE R GALE
Title or Position: INTERIM CFO
Credential:
Phone: 763-581-4635