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General NPI Number Information
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NPI Number | 1942687439
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Entity Type | Organization
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Legal Business Name | LETTLAND LLC
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 10845 CHARLEMAGNE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46259-1708
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Country | US
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Telephone | 317-796-0881
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Fax | 317-543-7881
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Provider Business Mailing Address
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Address Line | PO BOX 39057
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-0057
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Country | US
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Telephone | 317-796-0881
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Fax | 317-543-7881
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Authorized Official
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Title or Position | CEO
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Name | MR. GVIDO L BURGIS
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Credential |
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Telephone | 317-796-0881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 013663
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License Number State | IN
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