Provider Demographics
NPI:1265614242
Name:ADVACARE CLINICS,LTD
Entity type:Organization
Organization Name:ADVACARE CLINICS,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LENSELINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-835-6653
Mailing Address - Street 1:5001 AMERICAN BLVD W
Mailing Address - Street 2:STE.945
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1108
Mailing Address - Country:US
Mailing Address - Phone:952-835-6653
Mailing Address - Fax:952-835-3895
Practice Address - Street 1:5001 AMERICAN BLVD W
Practice Address - Street 2:STE.945
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1108
Practice Address - Country:US
Practice Address - Phone:952-835-6653
Practice Address - Fax:952-835-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X, 207Q00000X, 171100000X, 207R00000X, 225100000X, 261QP2300X, 208VP0000X, 208D00000X
MN401171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24-6608OtherCMS CERTIFICATION NUMBER PART A (CCN)
MNC02555Medicare UPIN