Provider Demographics
NPI:1851670400
Name:HEALTHY COMMUNITY SERVICES AGENCY, INC
Entity Type:Organization
Organization Name:HEALTHY COMMUNITY SERVICES AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AI
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:651-247-6517
Mailing Address - Street 1:1096 RICE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-4922
Mailing Address - Country:US
Mailing Address - Phone:651-247-6517
Mailing Address - Fax:651-487-7545
Practice Address - Street 1:1096 RICE ST.
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117
Practice Address - Country:US
Practice Address - Phone:651-247-6517
Practice Address - Fax:651-487-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN353118251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health