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General NPI Number Information
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NPI Number | 1295901056
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Entity Type | Organization
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Legal Business Name | HISBIZMN, DBA COMFORT KEEPERS #424
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 7940 RANCHERS RD NE STE B
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City | FRIDLEY
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State | MN
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Zip | 55432-1804
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Country | US
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Telephone | 763-785-0387
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Fax |
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Provider Business Mailing Address
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Address Line | 7940 RANCHERS RD NE STE B
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City | FRIDLEY
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State | MN
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Zip | 55432-1804
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Country | US
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Telephone | 763-785-0387
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KELLY MARIE LINDELL
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Credential |
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Telephone | 763-785-0387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 337496
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License Number State | MN
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