Provider Demographics
NPI:1194064063
Name:RUSCIANO - HYLAND, INC.
Entity type:Organization
Organization Name:RUSCIANO - HYLAND, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-646-3835
Mailing Address - Street 1:7320 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4513
Mailing Address - Country:US
Mailing Address - Phone:612-871-3885
Mailing Address - Fax:952-928-9857
Practice Address - Street 1:7320 OXFORD ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55426-4513
Practice Address - Country:US
Practice Address - Phone:612-871-3885
Practice Address - Fax:952-928-9857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care