Provider Demographics
NPI:1942687439
Name:LETTLAND LLC
Entity Type:Organization
Organization Name:LETTLAND LLC
Other - Org Name:SERENITY CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GVIDO
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-796-0881
Mailing Address - Street 1:PO BOX 39057
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-0057
Mailing Address - Country:US
Mailing Address - Phone:317-796-0881
Mailing Address - Fax:317-543-7881
Practice Address - Street 1:10845 CHARLEMAGNE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46259-1708
Practice Address - Country:US
Practice Address - Phone:317-796-0881
Practice Address - Fax:317-543-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN013663253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN013663OtherPERSONAL SERVICE AGENCY