Provider Demographics
NPI:1538862230
Name:MIINEHEALTH, INC.
Entity type:Organization
Organization Name:MIINEHEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ALIX
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-690-7870
Mailing Address - Street 1:4640 SASSAFRAS LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-1139
Mailing Address - Country:US
Mailing Address - Phone:708-690-6760
Mailing Address - Fax:
Practice Address - Street 1:4640 SASSAFRAS LN
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-1139
Practice Address - Country:US
Practice Address - Phone:708-690-6760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty