1538945092 NPI number — THE LANDING OF MINNESOTA, 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 1538945092 NPI number — THE LANDING OF MINNESOTA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LANDING OF MINNESOTA, 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:
1538945092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1295 NORTHLAND DR STE 270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENDOTA HEIGHTS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55120-1373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-900-7021
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1585 RICE ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-526-3454
Provider Business Practice Location Address Fax Number:
651-448-2147
Provider Enumeration Date:
08/31/2023

Additional Information

Authorized Official

Authorized Official Last Name:
UTRZAN
Authorized Official First Name:
DAMIR
Authorized Official Middle Name:
STEVAN
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
612-900-7021

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1118449 . This is a "DEPARTMENT OF HUMAN SERVICES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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