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General NPI Number Information
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NPI Number | 1699028704
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Entity Type | Organization
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Legal Business Name | DAYSPRING SUPPORTIVE LIVING SERVICES
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Dates
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Enumeration Date | 10/26/2012
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Last Update Date | 10/26/2012
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Provider Practice Location Address
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Address Line | 42650 290TH ST
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City | AITKIN
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State | MN
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Zip | 56431-4567
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Country | US
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Telephone | 218-839-6909
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Fax |
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Provider Business Mailing Address
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Address Line | 42650 290TH ST
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City | AITKIN
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State | MN
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Zip | 56431-4567
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CALLIEGH NOEL JOHNSON
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Credential |
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Telephone | 218-839-6909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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