WHITE BEAR AREA SENIOR PROGAM ISD 624 NPI 1134588031

NPI Information

  • NPI: 1134588031
  • Provider Name: WHITE BEAR AREA SENIOR PROGAM ISD 624
  • Classification: Home Delivered Meals - 332U00000X
  • Entity Type: Organization
  • CLIA Number: 24D0723208
  • Address: 2484 COUNTY ROAD F E
    WHITE BEAR LAKE, MN
    ZIP 55110
  • Phone: (612) 623-3363

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NPI Details

WHITE BEAR AREA SENIOR PROGAM ISD 624 is a home delivered meals in White Bear Lake, MN. The provider is home-delivered meals are those services or activities designed to prepare and deliver one or more meals a day to an individual's residence in order to prevent institutionalization, malnutrition, and feelings of isolation. Component services or activities may include the cost of personnel, equipment, and food; assessment of nutritional and dietary needs; nutritional education and counseling; socialization services; and information and referral. WHITE BEAR AREA SENIOR PROGAM ISD 624 NPI is 1134588031. The provider is registered as an organization entity type.

The provider's business location address is:

2484 COUNTY ROAD F E
WHITE BEAR LAKE, MN
ZIP 55110-404
Phone: (612) 623-3363

The provider's authorized official is Wayne Kazmierczak .
The authorized official title is Director and has the following contact phone number (612) 623-3363.

The CLIA number assigned to this NPI record is 24D0723208 - ambulance with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/19/2016 and was last updated on 2/19/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332U00000XHome Delivered MealsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1A365023500MEDICAIDMINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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