Healthcare Provider Details

I. General information

NPI: 1962575811
Provider Name (Legal Business Name): MADELIA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DREW AVENUE SE
MADELIA MN
56062-1841
US

IV. Provider business mailing address

121 DREW AVENUE SE
MADELIA MN
56062-1841
US

V. Phone/Fax

Practice location:
  • Phone: 507-642-3255
  • Fax: 507-642-8516
Mailing address:
  • Phone: 507-642-3255
  • Fax: 507-642-8516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number351876
License Number StateMN

VIII. Authorized Official

Name: PRUDENCE TETZLOFF
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 507-642-3255