1104052976 NPI number — DIVINE NURTURING ALLIANCE OF CARING, INC.

Table of content: MR. SOSING TSUI L. AC. (NPI 1205900255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104052976 NPI number — DIVINE NURTURING ALLIANCE OF CARING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVINE NURTURING ALLIANCE OF CARING, 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:
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:
1104052976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7964 BROOKLYN BLVD
Provider Second Line Business Mailing Address:
SUITE 216
Provider Business Mailing Address City Name:
BROOKLYN PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55445-2722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-463-5911
Provider Business Mailing Address Fax Number:
763-494-3782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7964 BROOKLYN BLVD
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
BROOKLYN PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55445-2722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-463-5911
Provider Business Practice Location Address Fax Number:
763-494-3782
Provider Enumeration Date:
06/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BASSEY-BLACK
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
O
Authorized Official Title or Position:
ODS
Authorized Official Telephone Number:
763-463-5911

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  343974 , 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)

  • Identifier: A607463100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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