Provider Demographics
NPI:1497846810
Name:METRO PCA SERVICES, INC.
Entity Type:Organization
Organization Name:METRO PCA SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YOUA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-647-0647
Mailing Address - Street 1:345 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-2091
Mailing Address - Country:US
Mailing Address - Phone:651-647-0647
Mailing Address - Fax:651-647-1075
Practice Address - Street 1:345 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-2091
Practice Address - Country:US
Practice Address - Phone:651-647-0647
Practice Address - Fax:651-647-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1022449-2-AFC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN270460900Medicaid
MN408948100Medicaid
MN727622200Medicaid