Healthcare Provider Details

I. General information

NPI: 1093297368
Provider Name (Legal Business Name): STRIVE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 COUNTY ROAD 10 STE 512D
BROOKLYN CENTER MN
55429-3068
US

IV. Provider business mailing address

7419 ABBOTT AVE N
BROOKLYN PARK MN
55443-3529
US

V. Phone/Fax

Practice location:
  • Phone: 612-434-7039
  • Fax:
Mailing address:
  • Phone: 612-434-7039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. WALTER STILL III
Title or Position: MANAGING MEMBER
Credential:
Phone: 612-434-7039