Healthcare Provider Details

I. General information

NPI: 1831365030
Provider Name (Legal Business Name): SCANDIA SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 GODWARD ST NE STE 1300
MINNEAPOLIS MN
55413-1881
US

IV. Provider business mailing address

15622 135TH ST
FORESTON MN
56330-9537
US

V. Phone/Fax

Practice location:
  • Phone: 651-335-1586
  • Fax:
Mailing address:
  • Phone: 320-294-5898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number339803
License Number StateMN

VIII. Authorized Official

Name: JUSTIN BURKE
Title or Position: MANAGING MEMBER
Credential:
Phone: 651-335-1586