Provider Demographics
NPI:1336228626
Name:HEALTHY SOLES INC.
Entity Type:Organization
Organization Name:HEALTHY SOLES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:952-994-4438
Mailing Address - Street 1:17029 CLEAR SPRING TER
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4318
Mailing Address - Country:US
Mailing Address - Phone:952-994-4438
Mailing Address - Fax:
Practice Address - Street 1:17029 CLEAR SPRING TER
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4318
Practice Address - Country:US
Practice Address - Phone:952-994-4438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24407251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24407OtherCLASS A HOME CARE LICENSU