Healthcare Provider Details

I. General information

NPI: 1861305096
Provider Name (Legal Business Name): SPRUCE AND SQUARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2061 PATRICIA ST
MENDOTA HEIGHTS MN
55120-1325
US

IV. Provider business mailing address

2061 PATRICIA ST
MENDOTA HEIGHTS MN
55120-1325
US

V. Phone/Fax

Practice location:
  • Phone: 763-913-4089
  • Fax:
Mailing address:
  • Phone: 763-913-4089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PATRICK SCOTT RATHMANN
Title or Position: OWNER
Credential:
Phone: 763-913-4089