Provider Demographics
NPI:1568197432
Name:AWAKENED WELLNESS LLC PRIVATE DUTY NURSING
Entity Type:Organization
Organization Name:AWAKENED WELLNESS LLC PRIVATE DUTY NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CANDEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:701-260-1847
Mailing Address - Street 1:222 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-4020
Mailing Address - Country:US
Mailing Address - Phone:701-260-1847
Mailing Address - Fax:
Practice Address - Street 1:222 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4020
Practice Address - Country:US
Practice Address - Phone:701-260-1847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care