Provider Demographics
NPI:1699558379
Name:STCH WAYZATA MN LLC
Entity type:Organization
Organization Name:STCH WAYZATA MN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARTNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-735-3656
Mailing Address - Street 1:7755 3RD ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5461
Mailing Address - Country:US
Mailing Address - Phone:651-735-3656
Mailing Address - Fax:
Practice Address - Street 1:13911 RIDGEDALE DR STE 190
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1700
Practice Address - Country:US
Practice Address - Phone:952-746-9649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STCH MN HOLDCO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-16
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based