1275651465 NPI number — CANSLER ENTERPRISES LLC

Table of content: (NPI 1275651465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275651465 NPI number — CANSLER ENTERPRISES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANSLER ENTERPRISES 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:
MOCKINGBIRD MANOR II
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:
1275651465
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:
5851 NE BARNES AVE
Provider Second Line Business Mailing Address:
P.O. BOX 25171
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64119-3821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-781-9035
Provider Business Mailing Address Fax Number:
816-453-4210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5851 NE BARNES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64119-3821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-453-4210
Provider Business Practice Location Address Fax Number:
816-453-4210
Provider Enumeration Date:
03/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RICKMAN CANSLER
Authorized Official First Name:
SUE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
816-289-3415

Provider Taxonomy Codes

  • Taxonomy code: 3104A0625X , with the licence number:  033747 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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