Provider Demographics
NPI:1588661276
Name:EQUITY SERVICES OF ST. PAUL, INC.
Entity Type:Organization
Organization Name:EQUITY SERVICES OF ST. PAUL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND C. E. O.
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-489-4656
Mailing Address - Street 1:1169 RICE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-4901
Mailing Address - Country:US
Mailing Address - Phone:651-489-4656
Mailing Address - Fax:651-489-4811
Practice Address - Street 1:1169 RICE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-4901
Practice Address - Country:US
Practice Address - Phone:651-489-4656
Practice Address - Fax:651-489-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN326508251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN064055700Medicaid
MN2120EQOtherBLUE CROSS
MN102018OtherUCARE
MN5900024OtherMEDICA
MN24822OtherHEALTH PARTNERS
MN5900024OtherMEDICA