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General NPI Number Information
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NPI Number | 1275846487
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Entity Type | Organization
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Legal Business Name | PAYNESVILLE AREA LIVING AT HOME BLOCK NURSE PROGRAM
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 1105 W MAIN ST
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City | PAYNESVILLE
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State | MN
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Zip | 56362-1000
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Country | US
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Telephone | 320-243-5144
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Fax | 320-243-5146
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Provider Business Mailing Address
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Address Line | 1105 W MAIN ST
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City | PAYNESVILLE
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State | MN
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Zip | 56362-1000
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Country | US
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Telephone | 320-243-5144
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Fax | 320-243-5146
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Authorized Official
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Title or Position | DIRECTOR
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Name | INEZ JONES
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Credential |
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Telephone | 320-243-5144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 1U-919
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License Number State | MN
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