Healthcare Provider Details

I. General information

NPI: 1053687996
Provider Name (Legal Business Name): MAINS'L SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 78TH AVE N
BROOKLYN PARK MN
55445-2744
US

IV. Provider business mailing address

7000 78TH AVE N
BROOKLYN PARK MN
55445-2744
US

V. Phone/Fax

Practice location:
  • Phone: 763-494-4553
  • Fax: 763-416-9198
Mailing address:
  • Phone: 763-494-4553
  • Fax: 763-416-9198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TERESA C. WILLIAMS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 763-494-4553