Provider Demographics
NPI:1255863536
Name:INTERNATIONAL QUALITY PCA SERVICES MN
Entity Type:Organization
Organization Name:INTERNATIONAL QUALITY PCA SERVICES MN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADERONKE
Authorized Official - Middle Name:O
Authorized Official - Last Name:MORDI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MBN, RN
Authorized Official - Phone:507-252-8117
Mailing Address - Street 1:3261 19TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6786
Mailing Address - Country:US
Mailing Address - Phone:507-252-8117
Mailing Address - Fax:507-252-1985
Practice Address - Street 1:3261 19TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6786
Practice Address - Country:US
Practice Address - Phone:507-252-8117
Practice Address - Fax:507-252-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care