Healthcare Provider Details

I. General information

NPI: 1568197432
Provider Name (Legal Business Name): AWAKENED WELLNESS LLC PRIVATE DUTY NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 07/23/2022
Certification Date: 07/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 2ND AVE SW
SIDNEY MT
59270-4020
US

IV. Provider business mailing address

222 2ND AVE SW
SIDNEY MT
59270-4020
US

V. Phone/Fax

Practice location:
  • Phone: 701-260-1847
  • Fax:
Mailing address:
  • Phone: 701-260-1847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TANYA L CANDEE
Title or Position: MANAGER
Credential: RN
Phone: 701-260-1847