Healthcare Provider Details

I. General information

NPI: 1508042540
Provider Name (Legal Business Name): WINDELS HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 OAK PARK BLVD. APT. #310
BLAINE MN
55449
US

IV. Provider business mailing address

1896 124TH LANE NE
BLAINE MN
55449
US

V. Phone/Fax

Practice location:
  • Phone: 651-263-3854
  • Fax:
Mailing address:
  • Phone: 651-263-3854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number338346
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number005105000
License Number StateMN

VIII. Authorized Official

Name: MR. DELAH M. AZUMAH
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 651-263-3854