Provider Demographics
NPI:1669549887
Name:PROVIDE CARE, INC.
Entity type:Organization
Organization Name:PROVIDE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-674-8312
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-0538
Mailing Address - Country:US
Mailing Address - Phone:651-674-8312
Mailing Address - Fax:651-674-8299
Practice Address - Street 1:4722 ISANTI TRL
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-5420
Practice Address - Country:US
Practice Address - Phone:651-674-8312
Practice Address - Fax:651-674-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN045822800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty