1831843515 NPI number — 221 LLC

Table of content: (NPI 1831843515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831843515 NPI number — 221 LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
221 LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831843515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 282071
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33630-2071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-928-7249
Provider Business Mailing Address Fax Number:
305-630-3632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1435 W 49TH PLACE
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33012-3147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-907-8526
Provider Business Practice Location Address Fax Number:
786-534-2493
Provider Enumeration Date:
02/10/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARCIA-PUERTO
Authorized Official First Name:
LAYANSI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-928-7249

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RS0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 116740500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".