Provider Demographics
NPI:1235458167
Name:INGRESS HEALTHCARE INC
Entity Type:Organization
Organization Name:INGRESS HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLALEYE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-261-5733
Mailing Address - Street 1:1020 W MEDICINE LAKE DR
Mailing Address - Street 2:#204
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-4513
Mailing Address - Country:US
Mailing Address - Phone:952-261-5733
Mailing Address - Fax:
Practice Address - Street 1:1020 W MEDICINE LAKE DR
Practice Address - Street 2:#204
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-4513
Practice Address - Country:US
Practice Address - Phone:952-261-5733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN348454251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health