Provider Demographics
NPI:1104930221
Name:INTERNATIONAL HEALTH CARE SERVICES
Entity type:Organization
Organization Name:INTERNATIONAL HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-591-1959
Mailing Address - Street 1:5801 DULUTH STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-591-1959
Mailing Address - Fax:763-591-0105
Practice Address - Street 1:5801 DULUTH STREET
Practice Address - Street 2:SUITE 310
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-591-1959
Practice Address - Fax:763-591-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330081251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN818045800Medicaid
MN818045800Medicaid