Provider Demographics
NPI:1871176537
Name:HEALTH ASSOCIATES PROFESSIONAL LLC
Entity type:Organization
Organization Name:HEALTH ASSOCIATES PROFESSIONAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMBA
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:763-568-5578
Mailing Address - Street 1:5747 W BROADWAY AVE STE 212D
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3881
Mailing Address - Country:US
Mailing Address - Phone:763-568-5578
Mailing Address - Fax:
Practice Address - Street 1:5747 W BROADWAY AVE STE 212D
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3881
Practice Address - Country:US
Practice Address - Phone:763-568-5578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care