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General NPI Number Information
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NPI Number | 1437957461
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Entity Type | Organization
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Legal Business Name | IDA'S HOUSE L.L.C.
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 1014 IVY AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55106-2082
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Country | US
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Telephone | 612-327-0573
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 431403
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City | BROOKLYN PARK
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State | MN
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Zip | 55443-7432
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Country | US
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Telephone | 612-327-0573
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/MANAGING AGENT
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Name | MR. LARRY DARNELL SCOTT
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Credential |
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Telephone | 612-327-0573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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