Healthcare Provider Details

I. General information

NPI: 1801617329
Provider Name (Legal Business Name): VIVO CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 146TH ST STE 110
BURNSVILLE MN
55337-4655
US

IV. Provider business mailing address

1000 E 146TH ST STE 110
BURNSVILLE MN
55337-4655
US

V. Phone/Fax

Practice location:
  • Phone: 952-688-9365
  • Fax:
Mailing address:
  • Phone: 952-688-9365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IDRIS ABDULLE
Title or Position: PRESIDENT
Credential:
Phone: 952-688-9365