Healthcare Provider Details

I. General information

NPI: 1700090479
Provider Name (Legal Business Name): HABILITATIVE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
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

220 MILWAUKEE ST STE 2
LAKEFIELD MN
56150-9495
US

V. Phone/Fax

Practice location:
  • Phone: 507-662-5236
  • Fax: 507-662-5235
Mailing address:
  • Phone: 507-662-5236
  • Fax: 507-662-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number333523
License Number StateMN

VIII. Authorized Official

Name: MR. DEVIN NELSON
Title or Position: CHIEF OPERATING OFFICER
Credential: COO
Phone: 507-662-5236