Provider Demographics
NPI:1679245468
Name:MITCHELL SENIOR SERVICES LLC
Entity Type:Organization
Organization Name:MITCHELL SENIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-746-2899
Mailing Address - Street 1:7575 GOLDEN VALLEY RD STE 378
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4572
Mailing Address - Country:US
Mailing Address - Phone:763-746-2899
Mailing Address - Fax:
Practice Address - Street 1:7575 GOLDEN VALLEY RD STE 378
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4572
Practice Address - Country:US
Practice Address - Phone:763-746-2899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care