Provider Demographics
NPI:1003261983
Name:LAO ADVANCEMENT ORGANIZATION OF AMERICA (LAOA)
Entity type:Organization
Organization Name:LAO ADVANCEMENT ORGANIZATION OF AMERICA (LAOA)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAMCHANH
Authorized Official - Middle Name:NMN
Authorized Official - Last Name:PHANTHAVONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-302-9154
Mailing Address - Street 1:2648 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-1004
Mailing Address - Country:US
Mailing Address - Phone:612-302-9154
Mailing Address - Fax:612-522-2431
Practice Address - Street 1:2648 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-1004
Practice Address - Country:US
Practice Address - Phone:612-302-9154
Practice Address - Fax:612-522-2431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1075697261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care