Organization
BLACK VINE LLC
Active
Other names
ComForcare Senior Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAM A MITCHELL (OWNER)
(952) 960-2266
Entity
Organization
Contact information
Practice address
4445 W 77TH ST, SUITE 122, EDINA, MN 55435-5133
(952) 960-2266
(952) 960-2267
Mailing address
4445 W 77TH ST, SUITE 122, EDINA, MN 55435-5133
(952) 960-2266
(952) 960-2267
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
348111
MN
Other
Enumeration date
06/25/2010
Last updated
06/25/2010
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