Healthcare Provider Details

I. General information

NPI: 1821770033
Provider Name (Legal Business Name): SOULFUL SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 07/21/2024
Certification Date: 07/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6803 CHANNEL RD NE
FRIDLEY MN
55432-4619
US

IV. Provider business mailing address

PO BOX 292
STILLWATER MN
55082-0292
US

V. Phone/Fax

Practice location:
  • Phone: 651-342-0813
  • Fax:
Mailing address:
  • Phone: 651-461-1421
  • Fax: 651-461-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare 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: JENNIFER VILLENEUVE
Title or Position: COO
Credential:
Phone: 651-208-5161