Provider Demographics
NPI:1013656792
Name:LISE LLC
Entity Type:Organization
Organization Name:LISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEKOU
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-260-8829
Mailing Address - Street 1:130 CINEMA DR APT 2112
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6397
Mailing Address - Country:US
Mailing Address - Phone:615-260-8829
Mailing Address - Fax:
Practice Address - Street 1:370 DOOLITTLE RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1129
Practice Address - Country:US
Practice Address - Phone:877-743-2646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty