Healthcare Provider Details

I. General information

NPI: 1447331483
Provider Name (Legal Business Name): MINNICK EDUCATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 DENT RD
ROANOKE VA
24019-4116
US

IV. Provider business mailing address

775 DENT RD
ROANOKE VA
24019-4116
US

V. Phone/Fax

Practice location:
  • Phone: 540-265-4281
  • Fax: 540-265-4287
Mailing address:
  • Phone: 540-265-4281
  • Fax: 540-265-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number635
License Number StateVA

VIII. Authorized Official

Name: FREIDA M KING
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 540-774-7100