Provider Demographics
NPI:1649661711
Name:MATTERS OF THE SPIRIT LLC
Entity type:Organization
Organization Name:MATTERS OF THE SPIRIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-432-0670
Mailing Address - Street 1:12645 W BURLEIGH RD STE 19
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-3102
Mailing Address - Country:US
Mailing Address - Phone:262-432-0670
Mailing Address - Fax:262-475-0412
Practice Address - Street 1:12645 W BURLEIGH RD STE 19
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3102
Practice Address - Country:US
Practice Address - Phone:262-432-0670
Practice Address - Fax:262-475-0412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No347C00000XTransportation ServicesPrivate Vehicle