Provider Demographics
NPI:1730835133
Name:SISU LIVING LLC
Entity type:Organization
Organization Name:SISU LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER & OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLENKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-292-0366
Mailing Address - Street 1:2107 TROOP DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4563
Mailing Address - Country:US
Mailing Address - Phone:320-292-0366
Mailing Address - Fax:
Practice Address - Street 1:2107 TROOP DR STE 201
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4563
Practice Address - Country:US
Practice Address - Phone:320-292-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1710764105OtherICS TRIPLEX