Organization
WHITE BEAR AREA SENIOR PROGAM ISD 624
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE KAZMIERCZAK (DIRECTOR)
(612) 623-3363
Entity
Organization
Contact information
Practice address
2484 COUNTY ROAD F E, WHITE BEAR LAKE, MN 55110-7404
(612) 623-3363
Mailing address
2484 COUNTY ROAD F E, WHITE BEAR LAKE, MN 55110-7404
Taxonomy
Speciality
Code
Description
License number
State
332U00000X
Home Delivered Meals
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A365023500
—
MN
Enumeration date
02/19/2016
Last updated
02/19/2016
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