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General NPI Number Information
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NPI Number | 1417595463
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Entity Type | Organization
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Legal Business Name | UBU SYNERGY SUPPORT LLC
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Dates
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Enumeration Date | 12/19/2019
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 5814 BLACKSHIRE PATH
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-1618
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Country | US
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Telephone | 651-300-6550
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Fax | 651-305-9395
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Provider Business Mailing Address
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Address Line | 8821 BRANSON DR
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-3524
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Country | US
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Telephone | 651-230-6774
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Fax | 651-305-9395
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | ALYSSA RUFF
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Credential |
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Telephone | 651-300-6550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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