Healthcare Provider Details

I. General information

NPI: 1295901056
Provider Name (Legal Business Name): HISBIZMN, DBA COMFORT KEEPERS #424
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7940 RANCHERS RD NE STE B
FRIDLEY MN
55432-1804
US

IV. Provider business mailing address

7940 RANCHERS RD NE STE B
FRIDLEY MN
55432-1804
US

V. Phone/Fax

Practice location:
  • Phone: 763-785-0387
  • Fax:
Mailing address:
  • Phone: 763-785-0387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number337496
License Number StateMN

VIII. Authorized Official

Name: MRS. KELLY MARIE LINDELL
Title or Position: OWNER
Credential:
Phone: 763-785-0387