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General NPI Number Information
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NPI Number | 1437656840
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Entity Type | Organization
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Legal Business Name | INNOVATIONS FOR AGING, LLC
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 3001 BROADWAY ST NE STE 170
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City | MINNEAPOLIS
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State | MN
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Zip | 55413-2374
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Country | US
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Telephone | 651-641-8612
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 BROADWAY ST NE STE 170
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City | MINNEAPOLIS
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State | MN
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Zip | 55413-2374
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Country | US
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Telephone | 651-641-8612
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MARK RICHARD CULLEN
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Credential |
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Telephone | 651-917-4649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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