Provider Demographics
NPI:1740517671
Name:STATELY CONSTRUCTION LLC
Entity type:Organization
Organization Name:STATELY CONSTRUCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEROLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-506-0337
Mailing Address - Street 1:504 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-1128
Mailing Address - Country:US
Mailing Address - Phone:317-506-0337
Mailing Address - Fax:765-778-3658
Practice Address - Street 1:504 W HIGH ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-1128
Practice Address - Country:US
Practice Address - Phone:317-506-0337
Practice Address - Fax:765-778-3658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty