Provider Demographics
NPI:1699902353
Name:U-SPAN SERVICES
Entity type:Organization
Organization Name:U-SPAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:OPIAMENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-235-3060
Mailing Address - Street 1:5637 BROOKLYN BLVD STE 200C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3061
Mailing Address - Country:US
Mailing Address - Phone:612-235-3060
Mailing Address - Fax:
Practice Address - Street 1:5637 BROOKLYN BLVD
Practice Address - Street 2:SUITE 200C
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3061
Practice Address - Country:US
Practice Address - Phone:612-235-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNER3445251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health