Provider Demographics
NPI:1457611386
Name:PREVENT 7
Entity Type:Organization
Organization Name:PREVENT 7
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICKOLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MICEK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:612-889-2031
Mailing Address - Street 1:2426 TOURNAMENT PLAYERS CIR S
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5502
Mailing Address - Country:US
Mailing Address - Phone:612-889-2031
Mailing Address - Fax:
Practice Address - Street 1:2426 TOURNAMENT PLAYERS CIR S
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5502
Practice Address - Country:US
Practice Address - Phone:612-889-2031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251G00000XAgenciesHospice Care, Community Based
No251V00000XAgenciesVoluntary or Charitable