1134347883 NPI number — LIGHTNING CREEK INVESTMENT GROUP INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134347883 NPI number — LIGHTNING CREEK INVESTMENT GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIGHTNING CREEK INVESTMENT GROUP 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:
GUEST HOME ESTATES I
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:
1134347883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 S MCGEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANEY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67333-1601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-879-5199
Provider Business Mailing Address Fax Number:
620-879-5291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S MCGEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANEY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67333-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-879-5199
Provider Business Practice Location Address Fax Number:
620-879-5291
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MADDUX
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
RAYNE
Authorized Official Title or Position:
OFFICE MGR
Authorized Official Telephone Number:
918-273-3649

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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