Healthcare Provider Details

I. General information

NPI: 1003000969
Provider Name (Legal Business Name): FULCRUM HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 FERNBROOK LANE NORTH SUITE 150
PLYMOUTH MN
55447-5350
US

IV. Provider business mailing address

3300 FERNBROOK LANE NORTH SUITE 150
PLYMOUTH MN
55447-5350
US

V. Phone/Fax

Practice location:
  • Phone: 763-204-8541
  • Fax: 763-204-8544
Mailing address:
  • Phone: 763-204-8541
  • Fax: 763-204-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA DENNIS
Title or Position: CEO
Credential:
Phone: 763-204-8541