Provider Demographics
NPI:1902833874
Name:FIRSTSOLUTIONS
Entity Type:Organization
Organization Name:FIRSTSOLUTIONS
Other - Org Name:SUPERIORHEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-740-2330
Mailing Address - Street 1:211 S BOUNDARY AVE
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:MN
Mailing Address - Zip Code:55810-2306
Mailing Address - Country:US
Mailing Address - Phone:218-624-4819
Mailing Address - Fax:
Practice Address - Street 1:211 S BOUNDARY AVE
Practice Address - Street 2:
Practice Address - City:PROCTOR
Practice Address - State:MN
Practice Address - Zip Code:55810-2306
Practice Address - Country:US
Practice Address - Phone:218-624-4819
Practice Address - Fax:218-624-7323
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRSTSOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-27
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN558210500Medicaid
MN558210500Medicaid