Healthcare Provider Details

I. General information

NPI: 1194548248
Provider Name (Legal Business Name): CANDICE CARENE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 2ND AVE S STE 500A
MINNEAPOLIS MN
55401-5510
US

IV. Provider business mailing address

5123 W 98TH ST # 1210
MINNEAPOLIS MN
55437-2040
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-4919
  • Fax: 855-454-2525
Mailing address:
  • Phone: 800-693-4919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CANDICE LANGLEY
Title or Position: PRESIDENT
Credential:
Phone: 917-723-1188