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General NPI Number Information
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NPI Number | 1477442143
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Entity Type | Organization
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Legal Business Name | BLANK SLATE HOMES LLC
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1148 PACIFIC ST
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City | SAINT PAUL
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State | MN
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Zip | 55106-6421
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Country | US
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Telephone | 612-770-5748
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 242
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City | CENTER CITY
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State | MN
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Zip | 55012-0242
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Country | US
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Telephone | 612-770-5748
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. ELIZABETH LEEANN GLENNA
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Credential | PT
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Telephone | 612-770-5748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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