Healthcare Provider Details

I. General information

NPI: 1922162759
Provider Name (Legal Business Name): DAKOTA COMMUNITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 W BROADWAY AVE
ROBBINSDALE MN
55422-2207
US

IV. Provider business mailing address

680 ONEILL DR
EAGAN MN
55121-1535
US

V. Phone/Fax

Practice location:
  • Phone: 651-688-8808
  • Fax: 651-688-8892
Mailing address:
  • Phone: 681-688-8808
  • Fax: 651-688-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number808486-1-RS
License Number StateMN

VIII. Authorized Official

Name: PAULA F HART
Title or Position: CEF
Credential:
Phone: 651-688-8808