Healthcare Provider Details

I. General information

NPI: 1699590406
Provider Name (Legal Business Name): SLORA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15741 FAIR HILL WAY
SAINT PAUL MN
55124-5256
US

IV. Provider business mailing address

15741 FAIR HILL WAY
APPLE VALLEY MN
55124
US

V. Phone/Fax

Practice location:
  • Phone: 763-316-8123
  • Fax:
Mailing address:
  • Phone: 763-316-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAED A SAED
Title or Position: FOUNDER
Credential:
Phone: 763-316-8123