Healthcare Provider Details

I. General information

NPI: 1932807088
Provider Name (Legal Business Name): VILLAGE INTEGRATED SERVICES AGENCY LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 COUNTY RD 10 SUITE 500G
BROOKLYN CENTER MN
55429
US

IV. Provider business mailing address

5803 XERXES AVE N APT 115
BROOKLYN CENTER MN
55430-2844
US

V. Phone/Fax

Practice location:
  • Phone: 763-443-4236
  • Fax: 763-647-7146
Mailing address:
  • Phone: 763-443-4236
  • Fax: 763-647-7146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY JEAN STINSON-ROYSTON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 763-443-4236