Organization
BIRCH BUNGALOW, LLC
Active
Parent organization
BIRCH BUNGALOW, LLC
Other names
Real Nutrition
Organization subpart
Yes
Provider details
NPI number
Legal business name
BIRCH BUNGALOW, LLC
Authorized official
KATRINA LEA MOUSER RD, LD (OWNER)
(218) 770-9788
Entity
Organization
Contact information
Practice address
25212 COUNTY HIGHWAY 124, FERGUS FALLS, MN 56537-8266
(218) 770-9788
Mailing address
25212 COUNTY HIGHWAY 124, FERGUS FALLS, MN 56537-8266
(218) 770-9788
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2913
MN
Other
Enumeration date
04/03/2017
Last updated
04/03/2017
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