Healthcare Provider Details

I. General information

NPI: 1629361092
Provider Name (Legal Business Name): VALLEY SENIOR SERVICES ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 NORWICH PARKWAY
OAK PARK HEIGHTS MN
55082
US

IV. Provider business mailing address

2845 HAMLINE AVE NORTH
ROSEVILLE MN
55113
US

V. Phone/Fax

Practice location:
  • Phone: 851-275-5801
  • Fax: 651-275-5802
Mailing address:
  • Phone: 651-631-6187
  • Fax: 651-631-6122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1064266-1-ADC
License Number StateMN

VIII. Authorized Official

Name: REBECCA A. CONWAY
Title or Position: EXECUTIVE DIRECTOR OF CREATIVE INDE
Credential:
Phone: 651-631-6123