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General NPI Number Information
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NPI Number | 1801143706
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Entity Type | Organization
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Legal Business Name | MCCULLOUGH CONTRACTORS LLC
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 15905 N FLORIDA AVE
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City | LUTZ
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State | FL
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Zip | 33549-8109
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Country | US
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Telephone | 813-963-5104
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Fax |
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Provider Business Mailing Address
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Address Line | 2702 COASTAL RANGE WAY
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City | LUTZ
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State | FL
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Zip | 33559-7346
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Country | US
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Telephone | 813-963-5104
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. CHARLES L MCCULLOUGH JR.
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Credential |
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Telephone | 813-963-5104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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