Provider Demographics
NPI:1588831002
Name:LLSC LTD.
Entity Type:Organization
Organization Name:LLSC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-737-8484
Mailing Address - Street 1:200 N WATER ST
Mailing Address - Street 2:SIDE ENTRANCE
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2057
Mailing Address - Country:US
Mailing Address - Phone:914-737-8484
Mailing Address - Fax:914-737-2089
Practice Address - Street 1:200 N WATER ST
Practice Address - Street 2:SIDE ENTRANCE
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2057
Practice Address - Country:US
Practice Address - Phone:914-737-8484
Practice Address - Fax:914-737-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02187680344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY344600000XMedicaid
NY02187680Medicaid