Healthcare Provider Details

I. General information

NPI: 1356841019
Provider Name (Legal Business Name): WOOD CREST BUILDING & REMODELING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24140 PRIMROSE LN N
SCANDIA MN
55073-9681
US

IV. Provider business mailing address

24140 PRIMROSE LN N
SCANDIA MN
55073-9681
US

V. Phone/Fax

Practice location:
  • Phone: 651-433-3779
  • Fax: 651-433-3771
Mailing address:
  • Phone: 651-433-3779
  • Fax: 651-433-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberBC628706
License Number StateMN

VIII. Authorized Official

Name: ERIK JAMES ANDERSON
Title or Position: BUILDING CONTRACTOR
Credential: CEO
Phone: 651-246-9457