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General NPI Number Information
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NPI Number | 1023538212
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Entity Type | Organization
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Legal Business Name | FIORAVANTI ENTERPRISES LLC
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2345 RICE ST STE 145
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City | ROSEVILLE
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State | MN
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Zip | 55113-3720
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Country | US
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Telephone | 952-392-1997
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Fax | 763-422-7059
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Provider Business Mailing Address
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Address Line | 2345 RICE ST STE 145
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City | ROSEVILLE
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State | MN
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Zip | 55113-3720
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Country | US
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Telephone | 952-392-1997
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Fax | 763-422-7059
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Authorized Official
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Title or Position | OWNER
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Name | MARC FIORAVANTI
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Credential |
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Telephone | 952-392-9117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 379134
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License Number State | MN
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