MEDICARE: DAKOTA COMMUNITIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310500000X	Mental Illness Intermediate Care Facility	808529-1-RS	MN

General Provider Information

NPI Number	:	1316000987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAKOTA COMMUNITIES INC

Provider Business Mailing Address
First Line	:	680 ONEILL DR
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55121-1535
Country	:	US
Telephone Number	:	651-688-8808
Fax Number	:	651-688-8892

Provider Business Practice Location Address
First Line	:	6525 EDGEWOOD AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55428-2422
Country	:	US
Telephone Number	:	651-688-8808
Fax Number	:	651-688-8892

Authorized Official
Title or Position	:	CEO
Name	:	PAULA F HART
Credential	:
Telephone Number	:	651-688-8808

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/22/2020

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