Organization
LIONGATE ENTERPRISE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICKENSON ARISTIL (OWNER)
(813) 504-9074
Entity
Organization
Contact information
Practice address
10407 N NEBRASKA AVE, TAMPA, FL 33612-6824
(813) 504-9074
Mailing address
10407 N NEBRASKA AVE, TAMPA, FL 33612-6824
(813) 504-9074
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
05/09/2019
Last updated
05/09/2019
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