Healthcare Provider Details

I. General information

NPI: 1235655879
Provider Name (Legal Business Name): DEFINE SUPPORTS PROFESSIONAL ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18830 ENGLISH AVE
FARMINGTON MN
55024-8962
US

IV. Provider business mailing address

18830 ENGLISH AVE
FARMINGTON MN
55024-8962
US

V. Phone/Fax

Practice location:
  • Phone: 218-310-3516
  • Fax:
Mailing address:
  • Phone: 218-310-3516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management 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: CHELSEA BALAMUT
Title or Position: FOUNDER
Credential:
Phone: 218-310-3516