Provider Demographics
NPI:1316125255
Name:CLOSSMAN CATERING LLC
Entity type:Organization
Organization Name:CLOSSMAN CATERING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER & GENERAL
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-828-8585
Mailing Address - Street 1:12200 32ND COURT NORTH
Mailing Address - Street 2:ATTN: COMPLIANCE DEPARTMENT
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1847
Mailing Address - Country:US
Mailing Address - Phone:727-828-8585
Mailing Address - Fax:727-571-1652
Practice Address - Street 1:3725 SYMMES RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015-3305
Practice Address - Country:US
Practice Address - Phone:513-942-7744
Practice Address - Fax:513-942-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0141662Medicaid