Healthcare Provider Details

I. General information

NPI: 1497582316
Provider Name (Legal Business Name): MARC DAVIS PAYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BROADWAY AVE N
ROCHESTER MN
55906-3720
US

IV. Provider business mailing address

113 BROADWAY AVE N
ROCHESTER MN
55906-3720
US

V. Phone/Fax

Practice location:
  • Phone: 507-206-0840
  • Fax: 507-206-0318
Mailing address:
  • Phone: 507-206-0840
  • Fax: 507-206-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number10832685
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: