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Organization
BOOMER RIDE
Active
Organization
BOOMER RIDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LESLIE DEAN HOWARD (OWNER)
(651) 263-0189
Entity
Organization
Contact information
Practice address
724 5TH ST W APT B, HASTINGS, MN 55033-1745
(651) 263-0189
Mailing address
724 5TH ST W APT B, HASTINGS, MN 55033-1745
(651) 263-0189
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
C893012006120
MN
Other
Enumeration date
11/17/2014
Last updated
11/17/2014
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