Healthcare Provider Details

I. General information

NPI: 1649454372
Provider Name (Legal Business Name): COMFORT CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5747 W BROADWAY AVE
CRYSTAL MN
55428-3572
US

IV. Provider business mailing address

5747 W BROADWAY AVE
CRYSTAL MN
55428-3572
US

V. Phone/Fax

Practice location:
  • Phone: 763-201-9565
  • Fax: 208-694-7048
Mailing address:
  • Phone: 763-201-9565
  • Fax: 208-694-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number338319
License Number StateMN

VIII. Authorized Official

Name: ANDREW VILENCHIK
Title or Position: PRESIDENT
Credential:
Phone: 763-201-9565