MEDICARE: ARTESIAN HOMES, LLC

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	253J00000X	Foster Care Agency	1054947-1-AFC	MN

General Provider Information

NPI Number	:	1700017753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARTESIAN HOMES, LLC

Provider Business Mailing Address
First Line	:	12416 71ST AVE SW
Second Line	:
City	:	MOTLEY
State	:	MN
Zip	:	56466-2509
Country	:	US
Telephone Number	:	218-352-6801
Fax Number	:	218-352-8081

Provider Business Practice Location Address
First Line	:	12416 71ST AVE SW
Second Line	:
City	:	MOTLEY
State	:	MN
Zip	:	56466-2509
Country	:	US
Telephone Number	:	218-352-6801
Fax Number	:	218-352-8081

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	PATRICIA RENE DANIELOWSKI
Credential	:
Telephone Number	:	218-352-6801

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	08/06/2009

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Directions to “ARTESIAN HOMES, LLC ” Practice Location

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