Organization
PREVENT 7
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICKOLAS JAMES MICEK MSW (DIRECTOR)
(612) 889-2031
Entity
Organization
Contact information
Practice address
2426 TOURNAMENT PLAYERS CIR S, BLAINE, MN 55449-5502
(612) 889-2031
Mailing address
2426 TOURNAMENT PLAYERS CIR S, BLAINE, MN 55449-5502
(612) 889-2031
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
Primary
—
—
251G00000X
Community Based Hospice Care Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
Other
Enumeration date
05/25/2012
Last updated
05/25/2012
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