Provider Demographics
NPI:1316212970
Name:HEADWINDS SOLUTIONS MN,LLC
Entity Type:Organization
Organization Name:HEADWINDS SOLUTIONS MN,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:612-767-2142
Mailing Address - Street 1:1011 W BROADWAY AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2531
Mailing Address - Country:US
Mailing Address - Phone:612-767-2142
Mailing Address - Fax:612-294-1661
Practice Address - Street 1:1011 W BROADWAY AVE
Practice Address - Street 2:STE 202
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2531
Practice Address - Country:US
Practice Address - Phone:612-767-2142
Practice Address - Fax:612-294-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1274888-2332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies