Provider Demographics
NPI:1962687111
Name:VIOLET M. DEILKE
Entity Type:Organization
Organization Name:VIOLET M. DEILKE
Other - Org Name:DBA CENTRE FOR HAIR AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:MARLENE
Authorized Official - Last Name:DEILKE
Authorized Official - Suffix:
Authorized Official - Credentials:HAIRLOSS SPECIALIST
Authorized Official - Phone:218-236-6000
Mailing Address - Street 1:420 CENTER AVE
Mailing Address - Street 2:SUITE #14
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-1957
Mailing Address - Country:US
Mailing Address - Phone:218-236-6000
Mailing Address - Fax:218-284-5889
Practice Address - Street 1:420 CENTER AVE
Practice Address - Street 2:SUITE #14
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-1957
Practice Address - Country:US
Practice Address - Phone:218-236-6000
Practice Address - Fax:218-284-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCO7557000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1B4G361CEOtherBCBS