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General NPI Number Information
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NPI Number | 1770328379
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Entity Type | Organization
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Legal Business Name | PROLIFIC ENTERPRISE LLC
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Dates
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Enumeration Date | 06/26/2024
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 9872 41ST ST NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-3062
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Country | US
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Telephone | 612-201-7894
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Fax |
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Provider Business Mailing Address
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Address Line | 9872 41ST ST NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-3062
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Country | US
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Telephone | 612-201-7894
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RICHMOND WILLIAM NAH
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Credential |
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Telephone | 612-201-7894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171WV0202X
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Taxonomy Name | Vehicle Modifications Contractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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