Provider Demographics
NPI:1043695729
Name:ALF EMPLOYER MINNESOTA, LLC
Entity type:Organization
Organization Name:ALF EMPLOYER MINNESOTA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARALEGAL
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-965-4240
Mailing Address - Street 1:78 CENTENNIAL LOOP
Mailing Address - Street 2:SUITE E
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7909
Mailing Address - Country:US
Mailing Address - Phone:547-373-7747
Mailing Address - Fax:541-746-5781
Practice Address - Street 1:1870 E SHORE DR
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-4248
Practice Address - Country:US
Practice Address - Phone:651-777-7787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN371210251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health