Provider Demographics
NPI:1275766750
Name:BLUE MEADOWS FAMILY RESOURCE CENTER, LLC
Entity Type:Organization
Organization Name:BLUE MEADOWS FAMILY RESOURCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:TERESE
Authorized Official - Last Name:BACHELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-399-9001
Mailing Address - Street 1:51652 120TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:MN
Mailing Address - Zip Code:56097-4410
Mailing Address - Country:US
Mailing Address - Phone:507-399-9001
Mailing Address - Fax:
Practice Address - Street 1:51652 120TH ST
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:MN
Practice Address - Zip Code:56097-4410
Practice Address - Country:US
Practice Address - Phone:507-399-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health