Provider Demographics
NPI:1629278445
Name:HAN HASTINGS, LLC
Entity Type:Organization
Organization Name:HAN HASTINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPERTY MGR - BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:LETOURNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-438-0418
Mailing Address - Street 1:1128 BAHLS DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-4500
Mailing Address - Country:US
Mailing Address - Phone:651-438-0418
Mailing Address - Fax:651-438-0419
Practice Address - Street 1:1128 BAHLS DR
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-4500
Practice Address - Country:US
Practice Address - Phone:651-438-0418
Practice Address - Fax:651-438-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN334492251E00000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA938912000Medicaid