Healthcare Provider Details

I. General information

NPI: 1699558379
Provider Name (Legal Business Name): STCH WAYZATA MN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13911 RIDGEDALE DR STE 190
MINNETONKA MN
55305-1700
US

IV. Provider business mailing address

7755 3RD ST N STE 200
OAKDALE MN
55128-5461
US

V. Phone/Fax

Practice location:
  • Phone: 952-746-9649
  • Fax:
Mailing address:
  • Phone: 651-735-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HEATH A BARTNESS
Title or Position: CEO
Credential:
Phone: 651-735-3656