| NPI | 1730128398 |
|---|---|
| Doing Business As | HEALTHEAST GRAND AVENUE CLINIC |
| Entity Type | Organization |
| Authorized Contact | DOUG DAVENPORT CFO 651-232-2250 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2015-05-21 |