Healthcare Provider Details

I. General information

NPI: 1598863615
Provider Name (Legal Business Name): MILS MINNESOTA INDEPENDENT LIVING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 BROADWAY ST NE SUITE 205
MINNEAPOLIS MN
55413-1962
US

IV. Provider business mailing address

2520 BROADWAY ST NE SUITE 205
MINNEAPOLIS MN
55413-1962
US

V. Phone/Fax

Practice location:
  • Phone: 612-379-4027
  • Fax: 612-379-3489
Mailing address:
  • Phone: 612-379-4027
  • Fax: 612-379-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number636054900
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NICOLE LEE REID
Title or Position: ADMINISTRATOR
Credential:
Phone: 612-379-4027