Provider Demographics
NPI:1508008525
Name:MACKMILLER DESIGN BUILD
Entity Type:Organization
Organization Name:MACKMILLER DESIGN BUILD
Other - Org Name:HOME FOR GOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACKMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CAPS
Authorized Official - Phone:952-949-8600
Mailing Address - Street 1:15694 VILLAGE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1441
Mailing Address - Country:US
Mailing Address - Phone:952-949-8600
Mailing Address - Fax:952-294-0262
Practice Address - Street 1:15694 VILLAGE WOODS DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1441
Practice Address - Country:US
Practice Address - Phone:952-949-8600
Practice Address - Fax:952-294-0262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20428435332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment