Organization
DREAMLIFE DESTINY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL PETERSON (OWNER)
(763) 226-3063
Entity
Organization
Contact information
Practice address
9488 KINGSVIEW LN N, MAPLE GROVE, MN 55369-8571
(612) 730-3436
Mailing address
9488 KINGSVIEW LN N, MAPLE GROVE, MN 55369-8571
(612) 730-3436
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
02/03/2023
Last updated
02/03/2023
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