Healthcare Provider Details

I. General information

NPI: 1689541617
Provider Name (Legal Business Name): HOUSE OF JOEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 7TH AVE S
SAINT CLOUD MN
56301-4327
US

IV. Provider business mailing address

527 7TH AVE S
SAINT CLOUD MN
56301-4327
US

V. Phone/Fax

Practice location:
  • Phone: 507-318-3490
  • Fax:
Mailing address:
  • Phone: 507-318-3490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: MARICUS LADELLE ROSEMAN
Title or Position: OWNER/MANAGER
Credential:
Phone: 507-318-3490