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General NPI Number Information
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NPI Number | 1659532950
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Entity Type | Organization
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Legal Business Name | PEDI-CARE, INC
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 02/19/2016
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Provider Practice Location Address
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Address Line | 17048 PATRICIA ST
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City | PAYNESVILLE
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State | MN
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Zip | 56362-9725
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Country | US
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Telephone | 612-356-0207
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Fax | 320-453-3579
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Provider Business Mailing Address
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Address Line | 17048 PATRICIA ST
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City | PAYNESVILLE
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State | MN
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Zip | 56362-9725
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Country | US
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Telephone | 612-345-0207
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Fax | 320-453-3579
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JENNIFER J RYAN
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Credential | RN
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Telephone | 612-356-0207
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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 | 340159
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License Number State | MN
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