Provider Demographics
NPI:1114674686
Name:FANTA VILLA LLC
Entity Type:Organization
Organization Name:FANTA VILLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCESS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-815-5499
Mailing Address - Street 1:30190 US HIGHWAY 19 N # 1234
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-1044
Mailing Address - Country:US
Mailing Address - Phone:727-386-8225
Mailing Address - Fax:
Practice Address - Street 1:19135 US HIGHWAY 19 N # 1234
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-3201
Practice Address - Country:US
Practice Address - Phone:727-386-8225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)