Provider Demographics
NPI:1659532950
Name:PEDI-CARE, INC
Entity Type:Organization
Organization Name:PEDI-CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-356-0207
Mailing Address - Street 1:17048 PATRICIA ST
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-9725
Mailing Address - Country:US
Mailing Address - Phone:612-345-0207
Mailing Address - Fax:320-453-3579
Practice Address - Street 1:17048 PATRICIA ST
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-9725
Practice Address - Country:US
Practice Address - Phone:612-356-0207
Practice Address - Fax:320-453-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN340159251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health