Provider Demographics
NPI:1902380504
Name:STAIRGODDESS, LLC
Entity Type:Organization
Organization Name:STAIRGODDESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-954-6797
Mailing Address - Street 1:10 E COLLEGE AVE STE 116AB
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5756
Mailing Address - Country:US
Mailing Address - Phone:920-205-4427
Mailing Address - Fax:920-954-9960
Practice Address - Street 1:10 E COLLEGE AVE STE 116AB
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5756
Practice Address - Country:US
Practice Address - Phone:920-205-4427
Practice Address - Fax:920-954-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty