Provider Demographics
NPI:1689054280
Name:TOUCH OF HEALTH WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:TOUCH OF HEALTH WELLNESS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MAJORITY PARTNER, FOUNDER, PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIBBY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:LARSON JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-922-8895
Mailing Address - Street 1:10417 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-3421
Mailing Address - Country:US
Mailing Address - Phone:952-922-8895
Mailing Address - Fax:952-922-8498
Practice Address - Street 1:10417 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-3421
Practice Address - Country:US
Practice Address - Phone:952-922-8895
Practice Address - Fax:952-922-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5137261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1841448727Medicaid
MN350004671Medicare PIN