Provider Demographics
NPI:1225129547
Name:ACCESS NORTH CENTER FOR INDEPENDENT LIVING OF NORTHEASTERN MINNESOTA
Entity Type:Organization
Organization Name:ACCESS NORTH CENTER FOR INDEPENDENT LIVING OF NORTHEASTERN MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRUNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-262-6675
Mailing Address - Street 1:1309 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746
Mailing Address - Country:US
Mailing Address - Phone:218-262-6675
Mailing Address - Fax:218-262-1401
Practice Address - Street 1:1309 E 40TH ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746
Practice Address - Country:US
Practice Address - Phone:218-262-6675
Practice Address - Fax:218-262-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN847517200OtherMHCP ID
MN629S9CEOtherBLUE PLUS ID
MN120062OtherFIRST PLAN BLUE
MN160 005OtherU CARE ID