1609919760 NPI number — DANCA LENNA INC

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 1609919760 NPI number — DANCA LENNA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANCA LENNA INC
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:
1609919760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1023 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWEET HOME
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97386-1515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1023 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWEET HOME
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97386-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-367-4231
Provider Business Practice Location Address Fax Number:
541-367-2825
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REDDEN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-367-4668

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  00506 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 056929 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3805097 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3805097 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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