Provider Demographics
NPI:1417038126
Name:ACR HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:ACR HEALTHCARE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:LEISTICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-294-4707
Mailing Address - Street 1:2437 RICE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3706
Mailing Address - Country:US
Mailing Address - Phone:651-484-5897
Mailing Address - Fax:651-203-0693
Practice Address - Street 1:2437 RICE ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3706
Practice Address - Country:US
Practice Address - Phone:651-484-5897
Practice Address - Fax:651-203-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN203638000Medicaid