Boomer Ride

NPI #1194121210 in Hastings, Minnesota

Provider Information

NPI Number: 1194121210
Entity Type: Organization
Organization Name: Boomer Ride
Primary Specialty: Private Vehicle
Enumeration Date: Nov 17, 2014
Last Updated: Nov 17, 2014

Practice Location

Address: 724 5TH ST W APT B
City: Hastings
State: Minnesota
ZIP Code: 55033-1745
Phone: (651) 263-0189

Authorized Official

Name: MR. LESLIE DEAN HOWARD
Title: OWNER
Phone: (651) 263-0189

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Private Vehicle	347C00000X	Primary

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