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General NPI Number Information
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NPI Number | 1477612802
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Entity Type | Organization
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Legal Business Name | WILD FLOWER HEALTH CARE SERVICES, INC.
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5200 ANNAPOLIS LN N
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City | PLYMOUTH
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State | MN
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Zip | 55446-3550
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Country | US
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Telephone | 763-227-3527
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Fax | 763-537-6817
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Provider Business Mailing Address
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Address Line | 6000 BASS LAKE RD SUITE # 208
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City | CRYSTAL
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State | MN
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Zip | 55429-2700
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Country | US
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Telephone | 763-551-4786
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Fax | 763-537-6817
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Authorized Official
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Title or Position | OWNER
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Name | GLORIA SAVAGE
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Credential |
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Telephone | 763-551-4786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 332696
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License Number State | MN
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