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General NPI Number Information
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NPI Number | 1568035764
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Entity Type | Organization
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Legal Business Name | DYNAMIK SERVICES INC
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Dates
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Enumeration Date | 07/23/2021
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 1010 DALE ST N
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City | SAINT PAUL
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State | MN
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Zip | 55117-5603
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Country | US
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Telephone | 612-333-4315
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Fax |
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Provider Business Mailing Address
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Address Line | 9913 EVERGREEN AVE N
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City | BROOKLYN PARK
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State | MN
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Zip | 55443-1557
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Country | US
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Telephone | 240-224-6296
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TERENCE LAINSI MUKONG
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Credential |
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Telephone | 612-461-8506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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