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Organization

HOMESTEAD DIVERSITY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
COURTNY SQUIBB (COO)
(515) 230-8902
Entity
Organization

Contact information

Practice address
3408 E 125TH ST, BURNSVILLE, MN 55337-3410
(515) 230-8902
Mailing address
3408 E 125TH ST, BURNSVILLE, MN 55337-3410
(515) 230-8902

Taxonomy

Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary

Other

Enumeration date
05/22/2023
Last updated
05/22/2023
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