Provider Demographics
NPI:1407553860
Name:SERVALL HEATHCARE LLC
Entity Type:Organization
Organization Name:SERVALL HEATHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GODHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-925-6016
Mailing Address - Street 1:4210 WILLOW RD N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1200
Mailing Address - Country:US
Mailing Address - Phone:702-888-2633
Mailing Address - Fax:612-688-5234
Practice Address - Street 1:4210 WILLOW RD N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1200
Practice Address - Country:US
Practice Address - Phone:702-888-2633
Practice Address - Fax:612-688-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company