Provider Demographics
NPI:1285486605
Name:1915 ENTERPRISE LLC
Entity type:Organization
Organization Name:1915 ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-712-0946
Mailing Address - Street 1:1914 RIVER CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7239
Mailing Address - Country:US
Mailing Address - Phone:813-712-0946
Mailing Address - Fax:
Practice Address - Street 1:1914 RIVER CROSSING DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7239
Practice Address - Country:US
Practice Address - Phone:813-712-0946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle