1104263599 NPI number — CKE LONGEVITY LLC

Table of content: LINDBERGH SALADIN (NPI 1972132652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104263599 NPI number — CKE LONGEVITY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CKE LONGEVITY LLC
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:
ELEMENTS THERAPEUTIC MASSAGE
Provider Other Organization Name Type Code:
3
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:
1104263599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14607 NW 23RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98685-1018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-574-3141
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1319 NE 134TH ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98685-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-574-3141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SWARTZ
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
360-574-3141

Provider Taxonomy Codes

  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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