Provider Demographics
NPI:1013140805
Name:817 MARSHALL AVE
Entity Type:Organization
Organization Name:817 MARSHALL AVE
Other - Org Name:KEY'S TO BEST HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PRIVTE DUTY NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANNA
Authorized Official - Middle Name:ROXANNE
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:763-202-8808
Mailing Address - Street 1:817 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6651
Mailing Address - Country:US
Mailing Address - Phone:763-202-8808
Mailing Address - Fax:651-291-2739
Practice Address - Street 1:817 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6651
Practice Address - Country:US
Practice Address - Phone:763-202-8808
Practice Address - Fax:651-291-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR171403-6251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care