Provider Demographics
NPI:1396948329
Name:FLAGSHIP FRANCHISES OF MN, LLC
Entity type:Organization
Organization Name:FLAGSHIP FRANCHISES OF MN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-465-0555
Mailing Address - Street 1:4833 W 123RD ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-1364
Mailing Address - Country:US
Mailing Address - Phone:952-465-0555
Mailing Address - Fax:952-465-0556
Practice Address - Street 1:4833 W 123RD ST
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-1364
Practice Address - Country:US
Practice Address - Phone:952-465-0555
Practice Address - Fax:952-465-0556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLAGSHIP FRANCHISES OF MN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-07
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1029148-2-ADC261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN317123000Medicaid