Provider Demographics
| NPI: | 1366984536 |
|---|---|
| Name: | ALLIED HEALTH CARE PROFESSIONAL SERVICE CORPORATION |
| Entity type: | Organization |
| Organization Name: | ALLIED HEALTH CARE PROFESSIONAL SERVICE CORPORATION |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | ADMINISTRATOR-CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | VICTORIA |
| Authorized Official - Middle Name: | KAREN |
| Authorized Official - Last Name: | MCGILL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | REGISTERED NURSE |
| Authorized Official - Phone: | 507-383-3517 |
| Mailing Address - Street 1: | 140 W CLARK ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | ALBERT LEA |
| Mailing Address - State: | MN |
| Mailing Address - Zip Code: | 56007-2546 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 507-668-4024 |
| Mailing Address - Fax: | 507-668-4023 |
| Practice Address - Street 1: | 140 W CLARK ST |
| Practice Address - Street 2: | |
| Practice Address - City: | ALBERT LEA |
| Practice Address - State: | MN |
| Practice Address - Zip Code: | 56007 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 507-668-4024 |
| Practice Address - Fax: | 507-668-4023 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2016-11-05 |
| Last Update Date: | 2018-06-13 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| MN | 141067-3 | 302R00000X, 251J00000X, 310400000X, 3104A0625X, 3104A0630X, 310500000X, 311ZA0620X, 314000000X, 3140N1450X, 385H00000X, 385HR2055X, 385HR2060X, 385HR2065X |
| 315P00000X | ||
| MN | 379183 | 251E00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 251E00000X | Agencies | Home Health | |
| No | 302R00000X | Managed Care Organizations | Health Maintenance Organization | |
| No | 251J00000X | Agencies | Nursing Care | |
| No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
| No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
| No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances |
| No | 310500000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | |
| No | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
| No | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility | |
| No | 3140N1450X | Nursing & Custodial Care Facilities | Skilled Nursing Facility | Nursing Care, Pediatric |
| No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | |
| No | 385H00000X | Respite Care Facility | Respite Care | |
| No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
| No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |
