Provider Demographics
NPI:1093942195
Name:IN-HOME CLINIC CONNECTION PC
Entity Type:Organization
Organization Name:IN-HOME CLINIC CONNECTION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:VALUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:C-NP
Authorized Official - Phone:952-842-9000
Mailing Address - Street 1:4570 W 77TH ST
Mailing Address - Street 2:SUITE 165
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5008
Mailing Address - Country:US
Mailing Address - Phone:952-230-7633
Mailing Address - Fax:952-842-9001
Practice Address - Street 1:4570 W 77TH ST
Practice Address - Street 2:SUITE 165
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5008
Practice Address - Country:US
Practice Address - Phone:952-230-7633
Practice Address - Fax:952-842-9001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IN-HOME LAB CONNECTION INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-16
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PENDING261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health