# ACTIVCARE SUPPORT SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366047813
- **Authorized official:** THANDIWE DEWA (PRESIDENT)
- **Authorized official phone:** (651) 983-3703

## Contact information

- **Practice address:** 7047 GOODVIEW AVE S, COTTAGE GROVE, MN 55016-2696
- **Practice address phone:** (651) 983-3703
- **Mailing address:** 7047 GOODVIEW AVE S, COTTAGE GROVE, MN 55016-2696
- **Mailing address phone:** (651) 983-3703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 12/02/2020
- **Last updated:** 12/07/2020