MEDICARE: SOUTHEASTERN MINNESOTA CENTER FOR INDEPENDENT LIVING

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		MN

General Provider Information

NPI Number	:	1972590933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN MINNESOTA CENTER FOR INDEPENDENT LIVING

Provider Business Mailing Address
First Line	:	2720 N BROADWAY
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-3980
Country	:	US
Telephone Number	:	507-285-1815
Fax Number	:	507-288-8070

Provider Business Practice Location Address
First Line	:	2720 N BROADWAY
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-3980
Country	:	US
Telephone Number	:	507-285-1815
Fax Number	:	507-288-8070

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. VICTORIA DALLE MOLLE
Credential	:	MPA
Telephone Number	:	507-285-3912

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	08/22/2020

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