OrganizationActive
Assisted Living Store, Incorporated
NPI 1629242102 · Durable Medical Equipment & Medical Supplies · Cottage Grove, MN
Provider details
- NPI number
- 1629242102
- Entity type
- Organization
- Primary specialty
- Durable Medical Equipment & Medical SuppliesSuppliers
- Organization subpart
- No
- Authorized official
- Kimberly Carlson, President(651) 769-1574
- License
- 4604156 (MN)
Specialties & taxonomies
Suppliers
Practice location
7687 Hyde Ave S
Cottage Grove, MN 55016-1978
Phone: (651) 769-1574
Fax: (651) 768-7575
Approximate (ZIP-level) locationGet directions
Mailing address
7687 Hyde Ave S
Cottage Grove, MN 55016-1978
Registry dates
- Enumerated
- 2008-04-16
- Last updated
- 2008-04-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.