Organization
SAND PINE PHEASANTS FAMILY RECREATION LLC
Active
Other names
Sand Pine Pheasants Family Recreation LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH JOSEPH SAND (OWNER)
(320) 363-4790
Entity
Organization
Contact information
Practice address
12195 NORWAY RD, AVON, MN 56310-4502
(320) 363-4790
(320) 363-4790
Mailing address
12195 NORWAY RD, AVON, MN 56310-4502
(320) 363-4790
(320) 363-4790
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/03/2019
Last updated
12/03/2019
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