Provider Demographics
NPI:1316473382
Name:ASSURED HEALTH LLC
Entity type:Organization
Organization Name:ASSURED HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:OGETTI
Authorized Official - Last Name:NYABERE
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:952-212-0911
Mailing Address - Street 1:8421 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2266
Mailing Address - Country:US
Mailing Address - Phone:952-212-0911
Mailing Address - Fax:651-300-1956
Practice Address - Street 1:8421 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445
Practice Address - Country:US
Practice Address - Phone:952-212-0911
Practice Address - Fax:651-300-1956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP0956261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care