Healthcare Provider Details

I. General information

NPI: 1760623235
Provider Name (Legal Business Name): ACCESSIBLE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 5TH AVE S
SOUTH ST PAUL MN
55075-3227
US

IV. Provider business mailing address

1104 5TH AVE S
SOUTH ST PAUL MN
55075-3227
US

V. Phone/Fax

Practice location:
  • Phone: 651-450-5629
  • Fax: 651-554-3085
Mailing address:
  • Phone: 651-450-5629
  • Fax: 651-554-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARISA ANNE RASMUSSEN
Title or Position: CHIEF MANAGER
Credential:
Phone: 612-978-1054