Provider Demographics
NPI:1982872693
Name:KOHLHASE
Entity Type:Organization
Organization Name:KOHLHASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BROKER AGENT
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLABAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-832-8370
Mailing Address - Street 1:6550 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-9041
Mailing Address - Country:US
Mailing Address - Phone:480-832-8370
Mailing Address - Fax:480-985-9411
Practice Address - Street 1:6550 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-9041
Practice Address - Country:US
Practice Address - Phone:480-832-8370
Practice Address - Fax:480-985-9411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOHLHASE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ150653251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage