Healthcare Provider Details

I. General information

NPI: 1255333530
Provider Name (Legal Business Name): COUNTY OF WABASHA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 HIAWATHA DR E
WABASHA MN
55981-1573
US

IV. Provider business mailing address

411 HIAWATHA DR E
WABASHA MN
55981-1573
US

V. Phone/Fax

Practice location:
  • Phone: 651-565-5200
  • Fax: 651-565-2637
Mailing address:
  • Phone: 651-565-5200
  • Fax: 651-565-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number325766
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateMN

VIII. Authorized Official

Name: MRS. JUDITH BARTON
Title or Position: DIRECTOR
Credential: PHN, DON
Phone: 651-565-5200