Provider Demographics
NPI:1740579267
Name:CYBERMATION, INC.
Entity Type:Organization
Organization Name:CYBERMATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:ARDOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-255-7027
Mailing Address - Street 1:415 3RD ST N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-2509
Mailing Address - Country:US
Mailing Address - Phone:320-255-7027
Mailing Address - Fax:320-255-7027
Practice Address - Street 1:415 3RD ST N
Practice Address - Street 2:SUITE 100
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-2509
Practice Address - Country:US
Practice Address - Phone:320-255-7027
Practice Address - Fax:320-255-7027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care