Healthcare Provider Details

I. General information

NPI: 1083533624
Provider Name (Legal Business Name): MARAVENT HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12423 66TH PL N
MAPLE GROVE MN
55369-6060
US

IV. Provider business mailing address

12423 66TH PL N
MAPLE GROVE MN
55369-6060
US

V. Phone/Fax

Practice location:
  • Phone: 612-940-9363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. KINGSLEY CHIGBU
Title or Position: CONSULTANT
Credential: PH.D., CFNIP, L.ICSW
Phone: 612-940-9363