1295589893 NPI number — 1ABSOLUTE SUPPLEMENTAL NURSING, 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 1295589893 NPI number — 1ABSOLUTE SUPPLEMENTAL NURSING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1ABSOLUTE SUPPLEMENTAL NURSING, 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:
1295589893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12152 JONQUIL ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COON RAPIDS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55433-1769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-280-3807
Provider Business Mailing Address Fax Number:
651-705-2770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12152 JONQUIL ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COON RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55433-1769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-280-3807
Provider Business Practice Location Address Fax Number:
651-705-2770
Provider Enumeration Date:
04/11/2024

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
763-280-3807

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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