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General NPI Number Information
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NPI Number | 1801378534
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Entity Type | Organization
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Legal Business Name | HOMESTYLE BUILDER, INC,
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Dates
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Enumeration Date | 08/29/2018
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 886 138TH AVE NW
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City | ANDOVER
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State | MN
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Zip | 55304-4100
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Country | US
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Telephone | 612-270-4049
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Fax |
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Provider Business Mailing Address
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Address Line | 886 138TH AVE NW
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City | ANDOVER
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State | MN
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Zip | 55304-4100
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Country | US
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Telephone | 612-270-4049
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. PETER A HAACK
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Credential |
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Telephone | 612-270-4049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | BC-721586
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License Number State | MN
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