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General NPI Number Information
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NPI Number | 1841441037
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Entity Type | Organization
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Legal Business Name | R&M WELTY INC.
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 6324 RIVERDALE DR NW
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City | RAMSEY
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State | MN
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Zip | 55303-4800
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Country | US
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Telephone | 763-355-9190
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Fax | 763-208-1665
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Provider Business Mailing Address
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Address Line | 6324 RIVERDALE DR NW
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City | RAMSEY
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State | MN
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Zip | 55303-4800
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Country | US
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Telephone | 763-753-9884
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Fax | 763-208-1665
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Authorized Official
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Title or Position | OWNER
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Name | MR. MYRON IMRI WELTY I
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Credential | REGISTERED NURSE
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Telephone | 763-753-9884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 1080415-1-HCBS
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License Number State | MN
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