Organization
THE MENAGE
Active
Other names
Menage LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRAVIS ANTHONY DOLLERSON JR. (CEO)
(651) 600-1161
Entity
Organization
Contact information
Practice address
11221 ZION ST NW, COON RAPIDS, MN 55433-3526
(651) 600-1161
Mailing address
11221 ZION ST NW, COON RAPIDS, MN 55433-3526
(651) 600-1161
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251E00000X
Home Health Agency
Primary
—
—
251T00000X
PACE Provider Organization
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861139560
NPI
MN
Enumeration date
05/16/2022
Last updated
08/25/2022
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