Provider Demographics
NPI:1518679406
Name:20151720 LLC
Entity Type:Organization
Organization Name:20151720 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIPARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:416-262-9539
Mailing Address - Street 1:36466 US 19
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684
Mailing Address - Country:US
Mailing Address - Phone:416-262-9539
Mailing Address - Fax:
Practice Address - Street 1:36466 US 19
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:416-262-9539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health