Provider Demographics
NPI:1699218206
Name:ROBERSONINCRESIDENTIALPROPERTYMANAGEMENTANDMAINTENANCESERVICE
Entity Type:Organization
Organization Name:ROBERSONINCRESIDENTIALPROPERTYMANAGEMENTANDMAINTENANCESERVICE
Other - Org Name:ROBERSONINCHOMECAREPCA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEFEXECUTIVEOFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:PCA
Authorized Official - Phone:612-707-2430
Mailing Address - Street 1:BOX 7
Mailing Address - Street 2:639 PROVIDENCE DR
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4550
Mailing Address - Country:US
Mailing Address - Phone:612-707-2430
Mailing Address - Fax:612-707-2430
Practice Address - Street 1:639 PROVIDENCE DR
Practice Address - Street 2:BOX 7
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4550
Practice Address - Country:US
Practice Address - Phone:612-707-2430
Practice Address - Fax:612-707-2430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERSONINCRESIDENTIALPROPERTYMANAGEMENTANDMAINTENANCESERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNPCA57407320161127251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health