Provider Demographics
NPI:1750872552
Name:MENTAL HEALTH NURSING LLC
Entity type:Organization
Organization Name:MENTAL HEALTH NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:952-270-1409
Mailing Address - Street 1:888 COUNTY ROAD D W STE 104
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-8519
Mailing Address - Country:US
Mailing Address - Phone:952-270-1409
Mailing Address - Fax:
Practice Address - Street 1:888 COUNTY ROAD D W STE 104
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-8519
Practice Address - Country:US
Practice Address - Phone:952-270-1409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty