Healthcare Provider Details

I. General information

NPI: 1710554928
Provider Name (Legal Business Name): FOUR LEAF LIQUIDATORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 DRUMMOND DR NW
MASSILLON OH
44646-9536
US

IV. Provider business mailing address

8550 DRUMMOND DR NW
MASSILLON OH
44646-9536
US

V. Phone/Fax

Practice location:
  • Phone: 133-071-5570
  • Fax:
Mailing address:
  • Phone: 133-071-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MIKE LANGENFELD
Title or Position: CEO
Credential:
Phone: 330-715-5705