Organization
MCCULLOUGH CONTRACTORS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES L MCCULLOUGH JR. (MANAGING MEMBER)
(813) 963-5104
Entity
Organization
Contact information
Practice address
15905 N FLORIDA AVE, LUTZ, FL 33549-8109
(813) 963-5104
Mailing address
2702 COASTAL RANGE WAY, LUTZ, FL 33559-7346
(813) 963-5104
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
—
Other
Enumeration date
08/09/2012
Last updated
08/09/2012
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