Provider Demographics
NPI:1194552836
Name:ISM OPCO L.L.C.
Entity type:Organization
Organization Name:ISM OPCO L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALCIDES
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGUI
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:813-447-9260
Mailing Address - Street 1:1701 68TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8744
Mailing Address - Country:US
Mailing Address - Phone:813-447-9260
Mailing Address - Fax:
Practice Address - Street 1:1701 68TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8744
Practice Address - Country:US
Practice Address - Phone:813-447-9260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISM OPCO L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility