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General NPI Number Information
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NPI Number | 1366907446
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Entity Type | Organization
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Legal Business Name | MOMENTS HOSPICE OF ST CLOUD LLC
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 2229 ROOSEVELT RD STE 1
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City | SAINT CLOUD
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State | MN
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Zip | 56301-5147
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Country | US
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Telephone | 320-372-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 820 LILAC DR N STE 210
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City | GOLDEN VALLEY
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State | MN
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Zip | 55422-4754
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Country | US
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Telephone | 952-220-6002
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIYAHU JAFFA
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Credential |
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Telephone | 715-800-0908
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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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