Habilitative Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

HABILITATIVE SERVICES, LLC

Practice address

1400 Madison Ave Ste 206
Mankato, MN 56001-5477

Phone

(507) 625-6047

NPI assigned

Oct 19, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brett Ian Cohen

Title

Coo

Phone

(800) 388-5150

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Habilitative Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Habilitative Services, Inc.

  • Home Health Agency
  • Lakefield, MN
  • NPI 1700090479
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677888000000",
    "number": "1992216766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S STE 500",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351878",
            "telephone_number": "952-563-2207",
            "fax_number": "952-922-6885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MADISON AVE STE 206",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015477",
            "telephone_number": "507-625-6047"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 9th St",
            "address_purpose": "LOCATION",
            "city": "Windom",
            "state": "MN",
            "postal_code": "561011746",
            "country_code": "US",
            "telephone_number": "507-831-5033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HABILITATIVE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-19",
        "last_updated": "2023-03-04",
        "certification_date": "2023-03-04",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "IAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "800-388-5150",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1070961-1-HCBS",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon James Gustafson
• Lynn K Gustafson, DPM
• Patricia R Gustafson, MS LP
• Kimberly Ann Haala, PH.D., L.P.
• Madison Claire Haberman
• Jessica Hadler, MDT/RDH
• April Haedt
• Michael Perry Haedt, O.D.
• Anna Marie Hagan
• Amy Hagen

• Community/Behavioral Health Agency in Mankato, MN
• Providers in Mankato, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.