Provider Demographics
NPI:1932629078
Name:INDEPENDENT HEALTHCARE RESOURCES, LLC.
Entity type:Organization
Organization Name:INDEPENDENT HEALTHCARE RESOURCES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HIRSI
Authorized Official - Middle Name:
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-607-4421
Mailing Address - Street 1:10 7TH AVE N APT 208
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8843
Mailing Address - Country:US
Mailing Address - Phone:612-607-4421
Mailing Address - Fax:
Practice Address - Street 1:393 DUNLAP ST N STE 820
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4343
Practice Address - Country:US
Practice Address - Phone:651-645-1090
Practice Address - Fax:651-645-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health