1962845537 NPI number — LIFESTYLE ADULT DAY CENTER, LLC

Table of content: DR. BRADLEY CHRISTOPHER DOAN D.C. (NPI 1598904096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962845537 NPI number — LIFESTYLE ADULT DAY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFESTYLE ADULT DAY CENTER, 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:
Provider Other Organization Name Type Code:
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:
1962845537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7089 10TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKDALE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55128-5938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-731-5154
Provider Business Mailing Address Fax Number:
651-714-9182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7089 10TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55128-5938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-731-5154
Provider Business Practice Location Address Fax Number:
651-714-9182
Provider Enumeration Date:
04/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
YANG
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER/MEMBER ORGANIZER
Authorized Official Telephone Number:
651-247-1737

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  1064601-1-ADC , 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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