Healthcare Provider Details

I. General information

NPI: 1083872527
Provider Name (Legal Business Name): KOTA CONNECTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2008
Last Update Date: 05/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 210TH ST W SUITE 148
LAKEVILLE MN
55044-5707
US

IV. Provider business mailing address

8500 210TH ST W SUITE 148
LAKEVILLE MN
55044-5707
US

V. Phone/Fax

Practice location:
  • Phone: 952-469-1555
  • Fax: 952-469-1478
Mailing address:
  • Phone: 952-469-1555
  • Fax: 952-469-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1009867-1-WS
License Number StateMN

VIII. Authorized Official

Name: MR. DAVID J. MODRYNSKI
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 952-469-1555