MEDICARE: DESVITO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	348146	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	348146	OTHER	MN	MINNESOTA DEPARTMENT OF HEALTH LICENSE

General Provider Information

NPI Number	:	1437475712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESVITO INC

Provider Business Mailing Address
First Line	:	17730 CEDAR TRL
Second Line	:
City	:	FERGUS FALLS
State	:	MN
Zip	:	56537-8214
Country	:	US
Telephone Number	:	218-205-9913
Fax Number	:

Provider Business Practice Location Address
First Line	:	9906 SCOTT AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-5429
Country	:	US
Telephone Number	:	612-203-9501
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. SCOTT T DEBRITO
Credential	:
Telephone Number	:	218-205-9913

Provider Enumeration Date	:	04/12/2010
Last Update Date	:	04/12/2010

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