| Classic Health Care, Llc | |
|
4748 Chicago Ave Suite #10 Minneapolis MN 55407-3515 | |
| (612) 916-0774 | |
| Not Available |
| Full Name | Classic Health Care, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 4748 Chicago Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Gretchen E Porter (OWNER) |
| Authorized Official Contact | 6129160774 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Classic Health Care, Llc 4748 Chicago Ave Suite #10 Minneapolis MN 55407-3515 Ph: (612) 916-0774 | Classic Health Care, Llc 4748 Chicago Ave Suite #10 Minneapolis MN 55407-3515 Ph: (612) 916-0774 |
| NPI Number | 1265703078 |
|---|---|
| Provider Enumeration Date | 01/25/2012 |
| Last Update Date | 01/25/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265703078 | NPI | - | NPPES |
| 492742700 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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