Provider Demographics
NPI:1497599724
Name:MRS ACQUISITION CORPORATION
Entity type:Organization
Organization Name:MRS ACQUISITION CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-333-2155
Mailing Address - Street 1:8053 E BLOOMINGTON FWY
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-4577
Mailing Address - Country:US
Mailing Address - Phone:612-333-2155
Mailing Address - Fax:612-333-5517
Practice Address - Street 1:8053 E BLOOMINGTON FWY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-4577
Practice Address - Country:US
Practice Address - Phone:612-333-2155
Practice Address - Fax:612-333-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty