MEDICARE: EDEN PRAIRIE MEALS ON WHEELS

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	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1700196938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN PRAIRIE MEALS ON WHEELS

Provider Business Mailing Address
First Line	:	PO BOX 44334
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-1334
Country	:	US
Telephone Number	:	952-221-2123
Fax Number	:	952-294-4730

Provider Business Practice Location Address
First Line	:	13600 TECHNOLOGY DR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-2251
Country	:	US
Telephone Number	:	952-221-2123
Fax Number	:	952-294-4730

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. THOMAS JOSEPH MEEHAN
Credential	:
Telephone Number	:	952-221-2123

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	10/21/2010

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