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General NPI Number Information
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NPI Number | 1558976753
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Entity Type | Organization
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Legal Business Name | STANFORD CO, LLC
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 130 E VINE ST
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City | OWATONNA
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State | MN
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Zip | 55060-2428
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Country | US
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Telephone | 507-676-3026
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Fax |
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Provider Business Mailing Address
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Address Line | 130 E VINE ST
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City | OWATONNA
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State | MN
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Zip | 55060-2428
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Country | US
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Telephone | 507-676-3026
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DARCI STANFORD
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Credential | BCCS
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Telephone | 507-676-3026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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