Provider Demographics
NPI:1386811537
Name:SUSTAINABLE RESOURCES CENTER INC
Entity type:Organization
Organization Name:SUSTAINABLE RESOURCES CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-870-4255
Mailing Address - Street 1:1081 10TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1312
Mailing Address - Country:US
Mailing Address - Phone:612-870-4255
Mailing Address - Fax:612-870-0729
Practice Address - Street 1:1081 10TH AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1312
Practice Address - Country:US
Practice Address - Phone:612-870-4255
Practice Address - Fax:612-870-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND82086Medicare UPIN