Provider Demographics
NPI:1063586238
Name:SWEET STRIPS
Entity type:Organization
Organization Name:SWEET STRIPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-461-4819
Mailing Address - Street 1:5465 W VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-9704
Mailing Address - Country:US
Mailing Address - Phone:402-461-4819
Mailing Address - Fax:
Practice Address - Street 1:120 LATHROP LN
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4033
Practice Address - Country:US
Practice Address - Phone:619-749-3756
Practice Address - Fax:619-334-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02798FMedicaid
CASR KH 97-473950OtherSELLER'S PERMIT -BOE
CA45650OtherHMDR LICENCE
CA1249790001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER