1154359586 NPI number — KTLA PROPERTIES LIMITED PARTNERSHIP

Table of content: (NPI 1154359586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154359586 NPI number — KTLA PROPERTIES LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KTLA PROPERTIES LIMITED PARTNERSHIP
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:
6
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:
1154359586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 HAZELTINE BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CHASKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55318-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-361-8000
Provider Business Mailing Address Fax Number:
952-361-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3902 KATELLA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-3304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-596-5561
Provider Business Practice Location Address Fax Number:
562-596-5516
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEICHERT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
952-361-8000

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  060000076 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZT06169G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 206301089 . This is a "OSHPD FACILITY NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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