1346567260 NPI number — SKK ENTERPRISES, LLC

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 1346567260 NPI number — SKK ENTERPRISES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKK 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:
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:
1346567260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10165 HENNEPIN TOWN RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55347-3104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-405-6220
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10165 HENNEPIN TOWN RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
EDEN PRAIRIE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55347-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-405-6220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MCNEILL
Authorized Official First Name:
MALCOLM
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
952-212-4337

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA0000 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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