Healthcare Provider Details

I. General information

NPI: 1144731928
Provider Name (Legal Business Name): HABILITATIVE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MILWAUKEE ST STE 2
LAKEFIELD MN
56150-9495
US

IV. Provider business mailing address

6600 FRANCE AVE S STE 500
EDINA MN
55435-1878
US

V. Phone/Fax

Practice location:
  • Phone: 952-922-6776
  • Fax: 952-922-6885
Mailing address:
  • Phone: 952-563-2207
  • Fax: 952-922-6885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DEVIN NELSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 952-922-6776