Healthcare Provider Details

I. General information

NPI: 1245120740
Provider Name (Legal Business Name): AUGUSTANA MOUNT OLIVET HOSPICE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 4TH AVE N STE 206
MINNEAPOLIS MN
55405-1178
US

IV. Provider business mailing address

1015 4TH AVE N STE 206
MINNEAPOLIS MN
55405-1178
US

V. Phone/Fax

Practice location:
  • Phone: 952-855-5041
  • Fax:
Mailing address:
  • Phone: 952-855-5041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SEELOCHANI STADTHERR
Title or Position: ASSOCIATE VP OF REVENUE CYCLE MGMT
Credential:
Phone: 952-855-5041