Provider Demographics
NPI:1609421080
Name:SOLOMON LLC
Entity Type:Organization
Organization Name:SOLOMON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ATAOBOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-456-8944
Mailing Address - Street 1:2301 PINE ST APT 12
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-3566
Mailing Address - Country:US
Mailing Address - Phone:651-456-8944
Mailing Address - Fax:763-324-8498
Practice Address - Street 1:2301 PINE ST APT 12
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3566
Practice Address - Country:US
Practice Address - Phone:651-456-8944
Practice Address - Fax:763-324-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care