Provider Demographics
NPI:1104140169
Name:SHAKOPEE MOBILE MEALS
Entity type:Organization
Organization Name:SHAKOPEE MOBILE MEALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HARCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-445-3058
Mailing Address - Street 1:1963 BOULDER PT
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3618
Mailing Address - Country:US
Mailing Address - Phone:952-445-3058
Mailing Address - Fax:
Practice Address - Street 1:1963 BOULDER PT
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3618
Practice Address - Country:US
Practice Address - Phone:952-445-3058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA470159300OtherHEALTH PARTNERS