Healthcare Provider Details

I. General information

NPI: 1730808288
Provider Name (Legal Business Name): TOP TIER BUILDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/28/2022
Certification Date: 08/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 CHICAGO AVE
MINNEAPOLIS MN
55407-2611
US

IV. Provider business mailing address

832 CASE AVE # 1
SAINT PAUL MN
55106-3804
US

V. Phone/Fax

Practice location:
  • Phone: 612-500-2094
  • Fax:
Mailing address:
  • Phone: 612-849-6889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHANS TILLMAN-LOUIS WILBURN IV
Title or Position: TRUSTEE
Credential:
Phone: 612-849-6889