1861721169 NPI number — METROPOLITAN LIVING, LLC

Table of content: (NPI 1861721169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861721169 NPI number — METROPOLITAN LIVING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN LIVING, 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:
1861721169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2105 W BURNSVILLE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURNSVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55337-4237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-564-3006
Provider Business Mailing Address Fax Number:
952-564-3038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 W 100TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55431-3125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-881-6424
Provider Business Practice Location Address Fax Number:
952-881-6586
Provider Enumeration Date:
12/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SAMMON
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
612-226-7120

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  26939 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 346596 . This is a "HOUSING WITH SERVICES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 345641 . This is a "CLASS F HOME CARE PROVIDER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 26939 . This is a "MN DEPARTMENT OF HEALTH LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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