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General NPI Number Information
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NPI Number | 1669939054
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Entity Type | Organization
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Legal Business Name | SISTERCARE, LLC.
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 311 S NICOLLET ST
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City | BLUE EARTH
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State | MN
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Zip | 56013-1313
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Country | US
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Telephone | 651-332-0497
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Fax |
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Provider Business Mailing Address
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Address Line | 1852 131ST LN NW
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City | COON RAPIDS
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State | MN
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Zip | 55448-1385
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Country | US
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Telephone | 651-500-9886
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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 | CAROLYN MAI DER XIONG
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Credential | PHARMD
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Telephone | 651-500-9886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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