1992924500 NPI number — SITMAN, INC.

Table of content: (NPI 1992924500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992924500 NPI number — SITMAN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SITMAN, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SITMAN, INC SUBSTANCE ABUSE TREATMENT
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992924500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 2ND AVE N STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TWIN FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83301-6158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-732-6112
Provider Business Mailing Address Fax Number:
208-732-6116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 2ND AVE N STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-6158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-732-6112
Provider Business Practice Location Address Fax Number:
208-732-6116
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELKIN
Authorized Official First Name:
INGA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
COUNSELOR
Authorized Official Telephone Number:
208-732-6112

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LMSW-26169 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8M880 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com