Provider Demographics
NPI:1700449568
Name:LIL INDIAN'S MOBILE MEALS LLC
Entity Type:Organization
Organization Name:LIL INDIAN'S MOBILE MEALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-881-1298
Mailing Address - Street 1:3662 LOVELAND RD.
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502
Mailing Address - Country:US
Mailing Address - Phone:330-881-1298
Mailing Address - Fax:
Practice Address - Street 1:3662 LOVELAND RD.
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502
Practice Address - Country:US
Practice Address - Phone:330-881-1298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals