Healthcare Provider Details

I. General information

NPI: 1952506263
Provider Name (Legal Business Name): SOLID FOUNDATIONS OF MN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32294 SUNNY BEACH RD
GRAND RAPIDS MN
55744-4872
US

IV. Provider business mailing address

3605 N 18TH ST
SUPERIOR WI
54880-2005
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-9281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number10422911WS
License Number StateMN

VIII. Authorized Official

Name: MRS. JENNIFER LOU SICKLER
Title or Position: PRESIDENT
Credential: MSE
Phone: 218-428-0434