Provider Demographics
NPI:1699590406
Name:SLORA LLC
Entity type:Organization
Organization Name:SLORA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SAED
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-316-8123
Mailing Address - Street 1:15741 FAIR HILL WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124
Mailing Address - Country:US
Mailing Address - Phone:763-316-8123
Mailing Address - Fax:
Practice Address - Street 1:15741 FAIR HILL WAY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55124-5256
Practice Address - Country:US
Practice Address - Phone:763-316-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health