Organization
CLASSIC HEALTH CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRETCHEN E PORTER ANP, LAC (OWNER)
(612) 916-0774
Entity
Organization
Contact information
Practice address
4748 CHICAGO AVE, SUITE #10, MINNEAPOLIS, MN 55407-3515
(612) 916-0774
Mailing address
4748 CHICAGO AVE, SUITE #10, MINNEAPOLIS, MN 55407-3515
(612) 916-0774
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
492742700
—
MN
Enumeration date
01/25/2012
Last updated
01/25/2012
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