Provider Demographics
NPI:1386826386
Name:CLINIQUE HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:CLINIQUE HEALTHCARE SERVICES, INC
Other - Org Name:CLINIQUE HEALTHCARE SERVICES, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:RN ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NNENNA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:ORJINTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-503-4757
Mailing Address - Street 1:6000 BASS LAKE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2765
Mailing Address - Country:US
Mailing Address - Phone:763-503-4757
Mailing Address - Fax:
Practice Address - Street 1:6000 BASS LAKE RD STE 204
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-2765
Practice Address - Country:US
Practice Address - Phone:763-503-4757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN338180251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health