Healthcare Provider Details

I. General information

NPI: 1700716768
Provider Name (Legal Business Name): HILLSIDE SUITES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 GREELEY ST S
STILLWATER MN
55082-6091
US

IV. Provider business mailing address

1675 GREELEY ST S
STILLWATER MN
55082-6091
US

V. Phone/Fax

Practice location:
  • Phone: 651-235-0964
  • Fax:
Mailing address:
  • Phone: 651-235-0964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBRA CHMIELESKI
Title or Position: CEO
Credential:
Phone: 651-235-0964