Healthcare Provider Details

I. General information

NPI: 1841335551
Provider Name (Legal Business Name): SCOTT CARVER DAKOTA CAP AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 CANTERBURY RD S
SHAKOPEE MN
55379-1840
US

IV. Provider business mailing address

712 CANTERBURY RD S
SHAKOPEE MN
55379-1840
US

V. Phone/Fax

Practice location:
  • Phone: 952-496-2125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY SULLIVAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 952-496-2125