Provider Demographics
NPI:1346800687
Name:VOSS HABERLE, BETTY KAREN (DIRECTOR)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:KAREN
Last Name:VOSS HABERLE
Suffix:
Gender:F
Credentials:DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24910 COUNTY ROAD 137
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTA
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9707
Mailing Address - Country:US
Mailing Address - Phone:320-260-5251
Mailing Address - Fax:320-251-5396
Practice Address - Street 1:1971 PINE CONE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4618
Practice Address - Country:US
Practice Address - Phone:320-260-5251
Practice Address - Fax:320-251-5396
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1039502385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care