Healthcare Provider Details

I. General information

NPI: 1659732360
Provider Name (Legal Business Name): INDEPENDENT LIVING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7714 BEECH ST NE
FRIDLEY MN
55432-2512
US

IV. Provider business mailing address

7714 BEECH ST NE
FRIDLEY MN
55432-2512
US

V. Phone/Fax

Practice location:
  • Phone: 612-743-7373
  • Fax: 763-571-5870
Mailing address:
  • Phone: 612-743-7373
  • Fax: 763-571-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberBC630902
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: BRENT MEGAHAN
Title or Position: PRESIDENT
Credential: CAPS
Phone: 612-743-7373