Organization
INDEPENDANCE MODIFICATIONS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENT RYAN KELSEY (PRESIDENT)
(651) 755-4459
Entity
Organization
Contact information
Practice address
24819 LEVER ST NE, ISANTI, MN 55040-4648
(651) 755-4459
(763) 444-6851
Mailing address
24819 LEVER ST NE, ISANTI, MN 55040-4648
(651) 755-4459
(763) 444-6851
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
20529716
MN
Other
Enumeration date
11/14/2006
Last updated
08/22/2020
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