1225892532 NPI number — DYNAMIC CARE SEVICE CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225892532 NPI number — DYNAMIC CARE SEVICE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC CARE SEVICE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225892532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 68TH LN N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN CENTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55430-5800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-272-8000
Provider Business Mailing Address Fax Number:
952-674-4459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 68TH LN N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN CENTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55430-5800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-272-8000
Provider Business Practice Location Address Fax Number:
952-674-4459
Provider Enumeration Date:
02/07/2024

Additional Information

Authorized Official

Authorized Official Last Name:
NCHOTU
Authorized Official First Name:
FLORENCE
Authorized Official Middle Name:
NGUM
Authorized Official Title or Position:
OWNER/ MANAGER
Authorized Official Telephone Number:
612-272-8000

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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