Provider Demographics
NPI:1699774521
Name:MINNESOTA AGE AND OPPORTUNITY
Entity type:Organization
Organization Name:MINNESOTA AGE AND OPPORTUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF SENIOR HEALTH AND NUTRITION
Authorized Official - Prefix:MS
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:REISER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:612-617-7817
Mailing Address - Street 1:2021 E HENNEPIN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2700
Mailing Address - Country:US
Mailing Address - Phone:612-617-7822
Mailing Address - Fax:612-379-0732
Practice Address - Street 1:2021 E HENNEPIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2700
Practice Address - Country:US
Practice Address - Phone:612-617-7822
Practice Address - Fax:612-379-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02153251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN247099Medicare ID - Type UnspecifiedMEDICARE PROV. #