Provider Demographics
NPI:1063641108
Name:ODIN VENTURES, INC. DBA DREAMMAKER BATH & KITCHEN
Entity Type:Organization
Organization Name:ODIN VENTURES, INC. DBA DREAMMAKER BATH & KITCHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-417-9999
Mailing Address - Street 1:6801 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1736
Mailing Address - Country:US
Mailing Address - Phone:952-417-9999
Mailing Address - Fax:952-417-9083
Practice Address - Street 1:6801 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1736
Practice Address - Country:US
Practice Address - Phone:952-417-9999
Practice Address - Fax:952-417-9083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3198999332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment