Provider Demographics
NPI:1053649632
Name:HEALTH ACTIVATION SERVICES, PLLC
Entity type:Organization
Organization Name:HEALTH ACTIVATION SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-398-8835
Mailing Address - Street 1:4080 W BROADWAY AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5604
Mailing Address - Country:US
Mailing Address - Phone:763-398-8835
Mailing Address - Fax:763-398-0670
Practice Address - Street 1:4080 W BROADWAY AVE
Practice Address - Street 2:#200
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5604
Practice Address - Country:US
Practice Address - Phone:763-398-8888
Practice Address - Fax:763-398-0670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH ACTIVATION SERVICES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-19
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1748261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine