=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316610249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELODY CARES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2021
-----------------------------------------------------
Last Update Date | 07/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1222 PINE ST W
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55082-5649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-503-8618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1222 PINE ST W
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55082-5649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-503-8618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOHN JACOB RENTSCHLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-503-8618
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------