Provider Demographics
NPI:1982213575
Name:SETTS PROVIDERLCAN LLC
Entity Type:Organization
Organization Name:SETTS PROVIDERLCAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LA SHEUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-560-9661
Mailing Address - Street 1:PO BOX 3315
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-3315
Mailing Address - Country:US
Mailing Address - Phone:347-560-9661
Mailing Address - Fax:646-968-0861
Practice Address - Street 1:465 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3555
Practice Address - Country:US
Practice Address - Phone:347-560-9661
Practice Address - Fax:646-968-0861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty