Organization Name: | MOUNT OLIVET ROLLING ACRES, INC |
NPI Number: | 1003172594 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KARI DOSE (OFFICE MANAGER) |
Mailing Address: | 1603 W Old Shakopee Rd Bloomington |
State: | MN US |
Postal Code: | 554313065 |
Phone Number: | 9524014868 |
Fax Number: | |
NPI Enumeration Date: | 04/09/2012 |
NPI Last Update Date: | 08/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SP0809X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Psych/Mental Health, Adult |
Taxonomy Definition: |