Provider Demographics
NPI:1912452475
Name:HEARSWELL, LLC
Entity Type:Organization
Organization Name:HEARSWELL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-444-4051
Mailing Address - Street 1:33 MAIN ST W
Mailing Address - Street 2:P.O. BOX 220
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-7156
Mailing Address - Country:US
Mailing Address - Phone:763-444-4051
Mailing Address - Fax:
Practice Address - Street 1:33 MAIN ST W
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-7156
Practice Address - Country:US
Practice Address - Phone:763-444-4051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2690261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225338916OtherNPPES