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General NPI Number Information
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NPI Number | 1144610403
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Entity Type | Organization
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Legal Business Name | REST EASY AT HOME HEALTH CARE AGENCY, LLC
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 1825 CURVE CREST BLVD W 200
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City | STILLWATER
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State | MN
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Zip | 55082-5090
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Country | US
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Telephone | 651-342-2478
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Fax | 651-342-0282
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Provider Business Mailing Address
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Address Line | 1825 CURVE CREST BLVD W 200
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City | STILLWATER
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State | MN
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Zip | 55082-5090
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Country | US
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Telephone | 651-342-2478
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Fax | 651-342-0282
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Authorized Official
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Title or Position | OWNER
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Name | WANDA FULTON HOCKENBERGER
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Credential |
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Telephone | 651-342-2478
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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 | 30914
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License Number State | MN
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