Healthcare Provider Details

I. General information

NPI: 1174795009
Provider Name (Legal Business Name): ADENA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 ST. CROIX TRAIL S SUITE 120
LAKELAND MN
55043
US

IV. Provider business mailing address

78 ST. CROIX TRAIL S SUITE 120
LAKELAND MN
55043
US

V. Phone/Fax

Practice location:
  • Phone: 612-328-1152
  • Fax:
Mailing address:
  • Phone: 612-328-1152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPENDING
License Number StateMN

VIII. Authorized Official

Name: DENA MARIE BELISLE
Title or Position: OWNER
Credential:
Phone: 612-328-1152