Healthcare Provider Details

I. General information

NPI: 1124875687
Provider Name (Legal Business Name): BACK PORCH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17831 76TH AVE N
MAPLE GROVE MN
55311-3784
US

IV. Provider business mailing address

17831 76TH AVE N
MAPLE GROVE MN
55311-3784
US

V. Phone/Fax

Practice location:
  • Phone: 612-695-5000
  • Fax:
Mailing address:
  • Phone: 612-695-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BAUERNFEIND
Title or Position: OWNER
Credential:
Phone: 612-695-5000