Provider Demographics
NPI:1932353505
Name:INTEGRA PCA SERVICES, INC.
Entity type:Organization
Organization Name:INTEGRA PCA SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-964-0372
Mailing Address - Street 1:20726 IBEX AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5867
Mailing Address - Country:US
Mailing Address - Phone:612-964-0372
Mailing Address - Fax:
Practice Address - Street 1:7845 BROOKLYN BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2721
Practice Address - Country:US
Practice Address - Phone:763-390-0578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health