1811527872 NPI number — SSUN HEALTH, LLC

Table of content: CALEB JOSHUA BONNER LMFT (NPI 1205209582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811527872 NPI number — SSUN HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSUN HEALTH, 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:
1811527872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10940 S PARKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80134-7440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-371-3782
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 SAINT MICHAELS DR STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-7604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-216-2364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LACOURT
Authorized Official First Name:
FRED
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
CHIEF DENTAL OFFICER
Authorized Official Telephone Number:
414-303-7484

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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