Healthcare Provider Details

I. General information

NPI: 1164195285
Provider Name (Legal Business Name): MILLS HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14809 MARGARET PL
MINNETONKA MN
55345-2102
US

IV. Provider business mailing address

14809 MARGARET PL
MINNETONKA MN
55345-2102
US

V. Phone/Fax

Practice location:
  • Phone: 612-481-8502
  • Fax: 612-454-2667
Mailing address:
  • Phone: 612-481-8502
  • Fax: 612-454-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MILLS HEALTH SERVICES
Title or Position: OPERATOR
Credential:
Phone: 612-481-8502