=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942950613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRON ADULT DAY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2022
-----------------------------------------------------
Last Update Date | 03/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6975 SAUKVIEW DR STE 100
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56303-1967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-345-5736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 399
-----------------------------------------------------
City | WAITE PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56387-0399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-345-5736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BENJAMIN THOMAS WARNE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 320-345-5736
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------