Provider Demographics
NPI:1710764105
Name:SISU LIVING LLC
Entity Type:Organization
Organization Name:SISU LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLENKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-292-0366
Mailing Address - Street 1:2107 TROOP DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4563
Mailing Address - Country:US
Mailing Address - Phone:320-292-0366
Mailing Address - Fax:
Practice Address - Street 1:125 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-4000
Practice Address - Country:US
Practice Address - Phone:320-292-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1730835133OtherIN HOME SUPPORTS