Provider Demographics
NPI:1528651106
Name:HOLM, SARA ANN
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:HOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:ROYALTON
Mailing Address - State:MN
Mailing Address - Zip Code:56373-3341
Mailing Address - Country:US
Mailing Address - Phone:320-232-0367
Mailing Address - Fax:
Practice Address - Street 1:831 N PINE ST
Practice Address - Street 2:
Practice Address - City:ROYALTON
Practice Address - State:MN
Practice Address - Zip Code:56373-3341
Practice Address - Country:US
Practice Address - Phone:320-232-0367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No253J00000XAgenciesFoster Care Agency