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General NPI Number Information
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NPI Number | 1174926240
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Entity Type | Organization
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Legal Business Name | ISD 622 GLADSTONE MEALS ON WHEELS
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Dates
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Enumeration Date | 10/03/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 1945 MANTON ST
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City | MAPLEWOOD
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State | MN
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Zip | 55109-4444
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Country | US
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Telephone | 612-623-3363
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Fax | 612-331-9401
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Provider Business Mailing Address
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Address Line | 1945 MANTON ST
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City | MAPLEWOOD
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State | MN
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Zip | 55109-4444
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Country | US
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Telephone | 612-623-3363
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Fax | 612-331-9401
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MARY PLASENCIA
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Credential |
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Telephone | 612-623-3363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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