Organization
ACTIVCARE SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THANDIWE DEWA (PRESIDENT)
(651) 983-3703
Entity
Organization
Contact information
Practice address
7047 GOODVIEW AVE S, COTTAGE GROVE, MN 55016-2696
(651) 983-3703
Mailing address
7047 GOODVIEW AVE S, COTTAGE GROVE, MN 55016-2696
(651) 983-3703
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
12/02/2020
Last updated
12/07/2020
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