Provider Demographics
NPI:1508036815
Name:ITASCA CORPORATION
Entity Type:Organization
Organization Name:ITASCA CORPORATION
Other - Org Name:ITASCA INTERPRETATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BYOM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:651-457-7400
Mailing Address - Street 1:1545 LIVINGSTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:W ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3414
Mailing Address - Country:US
Mailing Address - Phone:651-457-7400
Mailing Address - Fax:651-457-7700
Practice Address - Street 1:1545 LIVINGSTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:W ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3414
Practice Address - Country:US
Practice Address - Phone:651-457-7400
Practice Address - Fax:651-457-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty