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General NPI Number Information
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NPI Number | 1760735310
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Entity Type | Organization
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Legal Business Name | UNIVITA HOME HEALTH ASSESSMENTS OF OHIO LLC
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 11000 PRAIRIE LAKES DRIVE SUITE 600
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344
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Country | US
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Telephone | 952-456-4875
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Fax | 952-833-5489
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Provider Business Mailing Address
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Address Line | 11000 PRAIRIE LAKES DRIVE SUITE 600
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344
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Country | US
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Telephone | 952-456-4875
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Fax | 952-833-5489
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Authorized Official
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Title or Position | PRESIDENT, ENGAGEMENT SERVICES
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Name | MR. MARK REAGEN
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Credential |
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Telephone | 480-922-8942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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