1902302722 NPI number — LION YOUTH & COMMUNITY SERVICES LLC

Table of content: (NPI 1902302722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902302722 NPI number — LION YOUTH & COMMUNITY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LION YOUTH & COMMUNITY SERVICES 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:
1902302722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 25TH AVE S STE 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56301-4866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-420-1272
Provider Business Mailing Address Fax Number:
320-240-6814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 DIVISION ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHFIELD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55057-2430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-420-1272
Provider Business Practice Location Address Fax Number:
320-240-6814
Provider Enumeration Date:
04/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HANNA
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
LONGFELLOW
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
320-420-1272

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  2571659 , 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)





Copyright © 2007-2025 www.npivalidator.com