Healthcare Provider Details

I. General information

NPI: 1700017753
Provider Name (Legal Business Name): ARTESIAN HOMES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12416 71ST AVE SW
MOTLEY MN
56466-2509
US

IV. Provider business mailing address

12416 71ST AVE SW
MOTLEY MN
56466-2509
US

V. Phone/Fax

Practice location:
  • Phone: 218-352-6801
  • Fax: 218-352-8081
Mailing address:
  • Phone: 218-352-6801
  • Fax: 218-352-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number1054947-1-AFC
License Number StateMN

VIII. Authorized Official

Name: PATRICIA RENE DANIELOWSKI
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 218-352-6801