Provider Demographics
NPI:1497907265
Name:PAYNE PHALEN LIVING AT HOME BLOCK NURSE PROGRAM
Entity Type:Organization
Organization Name:PAYNE PHALEN LIVING AT HOME BLOCK NURSE PROGRAM
Other - Org Name:PAYNE PHALEN LAH/BNP
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVALLEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-774-7078
Mailing Address - Street 1:1280 ARCADE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2067
Mailing Address - Country:US
Mailing Address - Phone:651-774-7078
Mailing Address - Fax:
Practice Address - Street 1:1280 ARCADE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2067
Practice Address - Country:US
Practice Address - Phone:651-774-7078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care