Provider Demographics
NPI:1265032924
Name:STACCATO LLC
Entity Type:Organization
Organization Name:STACCATO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-844-2597
Mailing Address - Street 1:122 LEE PARKWAY DR STE 402
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-0813
Mailing Address - Country:US
Mailing Address - Phone:423-296-9117
Mailing Address - Fax:423-296-9172
Practice Address - Street 1:122 LEE PARKWAY DR STE 402
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-0813
Practice Address - Country:US
Practice Address - Phone:423-296-9117
Practice Address - Fax:423-296-9172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care