Provider Demographics
NPI:1144731928
Name:HABILITATIVE SERVICE, INC.
Entity type:Organization
Organization Name:HABILITATIVE SERVICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-922-6776
Mailing Address - Street 1:6600 FRANCE AVE S STE 500
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1878
Mailing Address - Country:US
Mailing Address - Phone:952-563-2207
Mailing Address - Fax:952-922-6885
Practice Address - Street 1:220 MILWAUKEE ST STE 2
Practice Address - Street 2:
Practice Address - City:LAKEFIELD
Practice Address - State:MN
Practice Address - Zip Code:56150-9495
Practice Address - Country:US
Practice Address - Phone:952-922-6776
Practice Address - Fax:952-922-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health