Healthcare Provider Details

I. General information

NPI: 1568013191
Provider Name (Legal Business Name): SIP BROTHERS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4618 85TH AVE N
BROOKLYN PARK MN
55443-1957
US

IV. Provider business mailing address

4618 85TH AVE N
BROOKLYN PARK MN
55443-1957
US

V. Phone/Fax

Practice location:
  • Phone: 612-245-9177
  • Fax:
Mailing address:
  • Phone: 612-245-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CALVIN SIPHAPASERTH
Title or Position: OWNER
Credential:
Phone: 612-245-9177