Healthcare Provider Details

I. General information

NPI: 1689371247
Provider Name (Legal Business Name): STAT IV 2 U
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2927 ADDISON DR
MELBOURNE FL
32940-7633
US

IV. Provider business mailing address

2927 ADDISON DR
MELBOURNE FL
32940-7633
US

V. Phone/Fax

Practice location:
  • Phone: 321-236-1070
  • Fax:
Mailing address:
  • Phone: 321-236-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: LENNY MARANZANO
Title or Position: OWNER/MANAGER
Credential: RN
Phone: 321-236-1070