Provider Demographics
NPI:1467233759
Name:RALPHVAN HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:RALPHVAN HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-600-2567
Mailing Address - Street 1:11500 WAYZATA BLVD # 1119
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2007
Mailing Address - Country:US
Mailing Address - Phone:651-600-2567
Mailing Address - Fax:
Practice Address - Street 1:3866 WESTBURY DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2080
Practice Address - Country:US
Practice Address - Phone:651-600-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)