1891880936 NPI number — SENIOR MANAGEMENT INC.

Table of content: (NPI 1891880936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891880936 NPI number — SENIOR MANAGEMENT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENIOR MANAGEMENT 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:
1891880936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 N BADGER ST
Provider Second Line Business Mailing Address:
P.O. BOX 112
Provider Business Mailing Address City Name:
CALEDONIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55921-0112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-725-3351
Provider Business Mailing Address Fax Number:
507-725-5142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 N BADGER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALEDONIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55921-0112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-725-3351
Provider Business Practice Location Address Fax Number:
507-725-5142
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THAYER
Authorized Official First Name:
GRANT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
507-269-6815

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  1033406-1-ADC , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 359436 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 359435 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 357654 , 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: NH0246 . This is a "U-CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1042964 . This is a "PREFERRED ONE-INPATIENT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 190176100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2R12CA . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1040058 . This is a "PREFERRED ONE-OUTPATIENT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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