1447911011 NPI number — AMERITUS PROPERTY FUND DURANGO LLC

Table of content: MR. AUSTIN SCOTT KLOSOSKY CPHT (NPI 1598140816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447911011 NPI number — AMERITUS PROPERTY FUND DURANGO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERITUS PROPERTY FUND DURANGO 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:
1447911011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 BROADWAY AVE S STE 460
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55904-7005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-361-3495
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 SUNSHINE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-6023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-385-4090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2022

Additional Information

Authorized Official

Authorized Official Last Name:
LANGE
Authorized Official First Name:
JORDAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE ADMINISTRATOR
Authorized Official Telephone Number:
507-251-6356

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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