Provider Demographics
NPI:1326317538
Name:PISIPATI LLC
Entity Type:Organization
Organization Name:PISIPATI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRABHAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PISIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-219-0675
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52733-0862
Mailing Address - Country:US
Mailing Address - Phone:563-219-0675
Mailing Address - Fax:
Practice Address - Street 1:550 33RD AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-1585
Practice Address - Country:US
Practice Address - Phone:563-242-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No282N00000XHospitalsGeneral Acute Care Hospital
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility