Provider Demographics
NPI:1336460518
Name:POR, LLC
Entity Type:Organization
Organization Name:POR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LP
Authorized Official - Phone:612-221-2441
Mailing Address - Street 1:14329 ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2230
Mailing Address - Country:US
Mailing Address - Phone:612-221-2441
Mailing Address - Fax:
Practice Address - Street 1:7380 FRANCE AVE S
Practice Address - Street 2:SUITE 209
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4535
Practice Address - Country:US
Practice Address - Phone:612-221-2441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health