1538244017 NPI number — EMPIRE STAR VENTURES LLC

Table of content: (NPI 1538244017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538244017 NPI number — EMPIRE STAR VENTURES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPIRE STAR VENTURES 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:
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:
1538244017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12410 E SINTO AVE
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
SPOKANE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99216-2199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-927-7827
Provider Business Mailing Address Fax Number:
509-928-7556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12410 E SINTO AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-2199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-927-7827
Provider Business Practice Location Address Fax Number:
509-928-7556
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAEFER
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
NORMAN
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
509-467-1244

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7123342 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0181044 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com