1821518929 NPI number — AS THE SUN

Table of content: (NPI 1821518929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821518929 NPI number — AS THE SUN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AS THE SUN
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:
1821518929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2120 60TH AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLMAR
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56201-9140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-905-4345
Provider Business Mailing Address Fax Number:
507-218-8492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3732 LAKESIDE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-8950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-905-4345
Provider Business Practice Location Address Fax Number:
320-905-4345
Provider Enumeration Date:
06/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LERE
Authorized Official First Name:
SABRINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
320-905-4345

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC0150 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1881936284 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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