Provider Demographics
NPI:1639458631
Name:ARIS IOP LLC
Entity Type:Organization
Organization Name:ARIS IOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-259-9750
Mailing Address - Street 1:7616 CURRELL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2295
Mailing Address - Country:US
Mailing Address - Phone:651-259-9750
Mailing Address - Fax:
Practice Address - Street 1:7616 CURRELL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2295
Practice Address - Country:US
Practice Address - Phone:651-259-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAYMOND J KENNEDY MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health