Provider Demographics
NPI:1124334982
Name:SECURITY ENTERPRISES 20 US LLC
Entity type:Organization
Organization Name:SECURITY ENTERPRISES 20 US LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA MARRTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-904-3887
Mailing Address - Street 1:830 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4911
Mailing Address - Country:US
Mailing Address - Phone:270-904-3887
Mailing Address - Fax:270-904-3887
Practice Address - Street 1:830 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4911
Practice Address - Country:US
Practice Address - Phone:270-904-3887
Practice Address - Fax:270-904-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site