Organization
ASSISTED LIVING STORE, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY ANN CARLSON (PRESIDENT)
(651) 769-1574
Entity
Organization
Contact information
Practice address
7687 HYDE AVE S, COTTAGE GROVE, MN 55016-1978
(651) 769-1574
(651) 768-7575
Mailing address
7687 HYDE AVE S, COTTAGE GROVE, MN 55016-1978
(651) 769-1574
(651) 768-7575
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
4604156
MN
Other
Enumeration date
04/16/2008
Last updated
04/16/2008
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