Provider Demographics
NPI:1730569484
Name:DIGNIFIED CHOICE CARE
Entity type:Organization
Organization Name:DIGNIFIED CHOICE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-392-8868
Mailing Address - Street 1:2004 RIVER HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:719-201-3843
Mailing Address - Fax:
Practice Address - Street 1:2004 RIVER HILLS DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1183
Practice Address - Country:US
Practice Address - Phone:952-392-8868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN367698253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherLICENCE BASIC HOME CARE