Healthcare Provider Details

I. General information

NPI: 1225382526
Provider Name (Legal Business Name): HEALTHEAST OUTPATIENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 UNIVERSITY AVE W 7TH FLOOR
SAINT PAUL MN
55104-3727
US

IV. Provider business mailing address

1700 UNIVERSITY AVE W 7TH FLOOR
SAINT PAUL MN
55104-3727
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-7000
  • Fax: 651-232-1187
Mailing address:
  • Phone: 651-232-7000
  • Fax: 651-232-1187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DOUG DAVENPORT
Title or Position: CFO
Credential:
Phone: 651-232-2250