Provider Demographics
NPI:1396314654
Name:INTEGRATIVE HEALTH, LLC
Entity type:Organization
Organization Name:INTEGRATIVE HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CALSEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FASCHING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:651-263-4388
Mailing Address - Street 1:7 YELLOW BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:DELLWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55110-1413
Mailing Address - Country:US
Mailing Address - Phone:651-263-4438
Mailing Address - Fax:
Practice Address - Street 1:988 INWOOD AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6625
Practice Address - Country:US
Practice Address - Phone:651-263-4438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty