Provider Demographics
NPI:1598863615
Name:MILS MINNESOTA INDEPENDENT LIVING SERVICES, INC
Entity Type:Organization
Organization Name:MILS MINNESOTA INDEPENDENT LIVING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-379-4027
Mailing Address - Street 1:2520 BROADWAY ST NE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1962
Mailing Address - Country:US
Mailing Address - Phone:612-379-4027
Mailing Address - Fax:612-379-3489
Practice Address - Street 1:2520 BROADWAY ST NE
Practice Address - Street 2:SUITE 205
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1962
Practice Address - Country:US
Practice Address - Phone:612-379-4027
Practice Address - Fax:612-379-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN636054900311Z00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0484690001Medicare NSC