Provider Demographics
NPI:1639861081
Name:FULCRUM HEALTH, INC.
Entity Type:Organization
Organization Name:FULCRUM HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-204-8541
Mailing Address - Street 1:3300 FERNBOOK LANE NORTH
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5350
Mailing Address - Country:US
Mailing Address - Phone:763-204-8570
Mailing Address - Fax:763-204-8544
Practice Address - Street 1:3300 FERNBOOK LANE NORTH
Practice Address - Street 2:SUITE 150
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5350
Practice Address - Country:US
Practice Address - Phone:763-204-8570
Practice Address - Fax:763-204-8544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULCRUM HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization