1174867006 NPI number — SUNDARI FOUNDATION, 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 1174867006 NPI number — SUNDARI FOUNDATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNDARI FOUNDATION, 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:
LOTUS HOUSE WOMEN'S SHELTER
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:
1174867006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1514 NW 15 STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33136-1860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-438-0556
Provider Business Mailing Address Fax Number:
305-438-0557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1514 NW 15TH STREET
Provider Second Line Business Practice Location Address:
SUITE # 1
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136-1860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-438-0556
Provider Business Practice Location Address Fax Number:
305-438-0557
Provider Enumeration Date:
11/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
CONSTANCE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
305-613-1573

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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