NPIMap

Organization Active NPI

Professional Resource Network, Inc

  • Community/Behavioral Health Agency
  • Bloomington, MN
National Provider Identifier
1346598547
Registry record updated Aug 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PROFESSIONAL RESOURCE NETWORK, INC
Practice address
2740 American Blvd W
Suite 100
Bloomington, MN 55431-1203
Phone
(952) 858-8827
Fax
(952) 858-8835
NPI assigned
Aug 17, 2012
Organization subpart
Yes
Parent organization
PROFESSIONAL RESOURCE NETWORK, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 17, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Charie L Devolites, RN, BSN, MSHCA
Title
Chief Executive Officer
Phone
(952) 858-8827

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

2740 American Blvd W
Suite 100
Bloomington, MN 55431-1203

Mailing address

2740 American Blvd W
Suite 100
Bloomington, MN 55431-1203
Phone (952) 858-8827

Other identifiers 1

IdentifierTypeStateIssuer
1710045430MedicaidMN

National Provider Directory

National Provider Directory
Tax ID family
Professional Resource Network Inc3 organizations share this tax ID, including this one
Part of
Professional Resource Network Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2740 American Blvd W
Ste 100
Bloomington, MN 55431
Phone (952) 854-6104

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345161600000",
    "number": "1346598547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 AMERICAN BLVD W",
            "address_2": "SUITE 100",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311203",
            "telephone_number": "952-858-8827",
            "fax_number": "952-858-8835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 AMERICAN BLVD W",
            "address_2": "SUITE 100",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311203",
            "telephone_number": "952-858-8827",
            "fax_number": "952-858-8835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL RESOURCE NETWORK, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROFESSIONAL RESOURCE NETWORK, INC",
        "enumeration_date": "2012-08-17",
        "last_updated": "2012-08-17",
        "status": "A",
        "authorized_official_last_name": "DEVOLITES",
        "authorized_official_first_name": "CHARIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "952-858-8827",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN, BSN, MSHCA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710045430",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.