1306456272 NPI number — SUNFLOWER HEALING ART THERAPY, LLC

Table of content: MRS. MARY KEELER RD, LD (NPI 1184287971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306456272 NPI number — SUNFLOWER HEALING ART THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNFLOWER HEALING ART THERAPY, 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:
1306456272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17915 LYLES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAGERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21740-9612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-285-9186
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1707 ROSEMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-285-9186
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KURTYKA
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, ART THERAPIST
Authorized Official Telephone Number:
240-285-9186

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 221700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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