1598863615 NPI number — MILS MINNESOTA INDEPENDENT LIVING SERVICES, INC

Table of content: (NPI 1598863615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598863615 NPI number — MILS MINNESOTA INDEPENDENT LIVING SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILS MINNESOTA INDEPENDENT LIVING SERVICES, INC
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:
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:
1598863615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2520 BROADWAY ST NE
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55413-1962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-379-4027
Provider Business Mailing Address Fax Number:
612-379-3489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 BROADWAY ST NE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55413-1962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-379-4027
Provider Business Practice Location Address Fax Number:
612-379-3489
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REID
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
612-379-4027

Provider Taxonomy Codes

  • Taxonomy code: 311Z00000X , with the licence number:  636054900 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com