Organization
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Active
Parent organization
GILLETTE CHILDRENS SPECIALTY HEALTHCARE
Other names
Gillette Children's Specialty Healthcare- Grove Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
GILLETTE CHILDRENS SPECIALTY HEALTHCARE
Authorized official
PATRICK NOLAN (CFO)
(651) 312-3105
Entity
Organization
Contact information
Practice address
9550 UPLAND LANE NORTH, SUITE 220, MAPLE GROVE, MN 55369
(651) 291-2848
Mailing address
200 UNIVERSITY AVE E, SAINT PAUL, MN 55101-2507
(651) 291-2848
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
MN
332BC3200X
Customized Equipment (DME)
—
MN
335E00000X
Prosthetic/Orthotic Supplier
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1111HGI
BLUE CROSS
MN
05
—
347487000
—
MN
Enumeration date
12/27/2007
Last updated
12/13/2019
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