Healthcare Provider Details

I. General information

NPI: 1518246263
Provider Name (Legal Business Name): ALISHA'S CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 COUNTY 38
EAGLE BEND MN
56446
US

IV. Provider business mailing address

12250 COUNTY 38
EAGLE BEND MN
56446
US

V. Phone/Fax

Practice location:
  • Phone: 320-732-8162
  • Fax: 320-732-8162
Mailing address:
  • Phone: 320-732-8162
  • Fax: 320-732-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY CLASEMAN
Title or Position: OWNER/BIRTH ASSISTANT
Credential:
Phone: 320-732-8162