Organization
INTEGRATED HOME AND COMMUNITY LIVING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ESTHER CHUMA (DIRECTOR)
(612) 208-4436
Entity
Organization
Contact information
Practice address
1534 LIBERTY CIR, SHAKOPEE, MN 55379-4545
(612) 208-4436
Mailing address
1534 LIBERTY CIR, SHAKOPEE, MN 55379-4545
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1051697-1-AFC
MN
Other
Enumeration date
09/24/2008
Last updated
09/24/2008
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