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General NPI Number Information
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NPI Number | 1194610857
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Entity Type | Organization
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Legal Business Name | MINDSTAR HEALTHCARE LLC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 215 2ND ST NW
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-1034
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Country | US
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Telephone | 612-407-3170
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Fax |
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Provider Business Mailing Address
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Address Line | 215 2ND ST NW
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-1034
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALEXZINE KIMBI
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Credential |
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Telephone | 612-407-3170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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