Healthcare Provider Details

I. General information

NPI: 1336228626
Provider Name (Legal Business Name): HEALTHY SOLES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17029 CLEAR SPRING TER
MINNETONKA MN
55345-4318
US

IV. Provider business mailing address

17029 CLEAR SPRING TER
MINNETONKA MN
55345-4318
US

V. Phone/Fax

Practice location:
  • Phone: 952-994-4438
  • Fax:
Mailing address:
  • Phone: 952-994-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number24407
License Number StateMN

VIII. Authorized Official

Name: MRS. LORI JAYNE STAMM
Title or Position: PRESIDENT
Credential: RN
Phone: 952-994-4438