Healthcare Provider Details

I. General information

NPI: 1780877373
Provider Name (Legal Business Name): WILDROSE HOME HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 N RIVERFRONT DR
MANKATO MN
56001-3341
US

IV. Provider business mailing address

18396 568TH AVE
MANKATO MN
56001-6649
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-8938
  • Fax: 507-625-9038
Mailing address:
  • Phone: 507-625-8938
  • Fax: 507-625-9038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberNA
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PAUL HAGEN
Title or Position: CEO
Credential:
Phone: 507-625-8938