Healthcare Provider Details

I. General information

NPI: 1275696841
Provider Name (Legal Business Name): DAKOTAS ADULTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 VICTORIA RD S
MENDOTA HEIGHTS MN
55118-4163
US

IV. Provider business mailing address

680 ONEILL DR
EAGAN MN
55121-1535
US

V. Phone/Fax

Practice location:
  • Phone: 651-688-8808
  • Fax: 651-688-8892
Mailing address:
  • Phone: 651-688-8808
  • Fax: 651-688-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number800613-1-RS
License Number StateMN

VIII. Authorized Official

Name: PAULA F HART
Title or Position: CEO
Credential:
Phone: 651-688-8808