Healthcare Provider Details

I. General information

NPI: 1629278445
Provider Name (Legal Business Name): HAN HASTINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 BAHLS DR
HASTINGS MN
55033-4500
US

IV. Provider business mailing address

1128 BAHLS DR
HASTINGS MN
55033-4500
US

V. Phone/Fax

Practice location:
  • Phone: 651-438-0418
  • Fax: 651-438-0419
Mailing address:
  • Phone: 651-438-0418
  • Fax: 651-438-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number334492
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARA KAYE LETOURNEAU
Title or Position: PROPERTY MGR - BILLING SPECIALIST
Credential:
Phone: 651-438-0418