Provider Demographics
NPI:1912647926
Name:THUNDERBEAR LLC
Entity Type:Organization
Organization Name:THUNDERBEAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:THONVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-322-8731
Mailing Address - Street 1:1329 VICTORIA CURV
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:MN
Mailing Address - Zip Code:55150-1611
Mailing Address - Country:US
Mailing Address - Phone:612-322-8731
Mailing Address - Fax:
Practice Address - Street 1:615 ANNE ST NW STE B
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4481
Practice Address - Country:US
Practice Address - Phone:218-333-8509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care