Provider Demographics
NPI:1427332220
Name:DOMINION RESOURCES, INC
Entity type:Organization
Organization Name:DOMINION RESOURCES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLADIPO
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-290-0459
Mailing Address - Street 1:1225 SW 304TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-3417
Mailing Address - Country:US
Mailing Address - Phone:952-290-0459
Mailing Address - Fax:888-206-4549
Practice Address - Street 1:555 3RD AVE NW STE B
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-1639
Practice Address - Country:US
Practice Address - Phone:320-864-9926
Practice Address - Fax:888-206-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN353272251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA686465000Medicaid