Provider Demographics
NPI:1700017753
Name:ARTESIAN HOMES, LLC
Entity Type:Organization
Organization Name:ARTESIAN HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:DANIELOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-352-6801
Mailing Address - Street 1:12416 71ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:MOTLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56466-2509
Mailing Address - Country:US
Mailing Address - Phone:218-352-6801
Mailing Address - Fax:218-352-8081
Practice Address - Street 1:12416 71ST AVE SW
Practice Address - Street 2:
Practice Address - City:MOTLEY
Practice Address - State:MN
Practice Address - Zip Code:56466-2509
Practice Address - Country:US
Practice Address - Phone:218-352-6801
Practice Address - Fax:218-352-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1054947-1-AFC253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency