Healthcare Provider Details

I. General information

NPI: 1811822455
Provider Name (Legal Business Name): MENAGE HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11221 ZION ST NW
COON RAPIDS MN
55433-3526
US

IV. Provider business mailing address

1144 28TH AVE N
SAINT CLOUD MN
56303-2328
US

V. Phone/Fax

Practice location:
  • Phone: 651-600-1161
  • Fax:
Mailing address:
  • Phone: 651-600-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome 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 Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS ANTHONY DOLLERSON
Title or Position: DIRECTOR
Credential:
Phone: 651-600-1161