Healthcare Provider Details

I. General information

NPI: 1164707717
Provider Name (Legal Business Name): R.G.GASS ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7365 KIRKWOOD CT N SUITE 345
MAPLE GROVE MN
55369-4721
US

IV. Provider business mailing address

7365 KIRKWOOD CT N SUITE 345
MAPLE GROVE MN
55369-4721
US

V. Phone/Fax

Practice location:
  • Phone: 612-486-4400
  • Fax: 612-486-4480
Mailing address:
  • Phone: 612-486-4400
  • Fax: 612-486-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number352031
License Number StateMN

VIII. Authorized Official

Name: MR. RICK G. GASS
Title or Position: OWNER
Credential:
Phone: 612-486-4023