Provider Demographics
NPI:1053073122
Name:FLETCHER ENTERPRISE LLC
Entity type:Organization
Organization Name:FLETCHER ENTERPRISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARETA
Authorized Official - Middle Name:KETURAH
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-379-7328
Mailing Address - Street 1:8 SAW MILL LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1572
Mailing Address - Country:US
Mailing Address - Phone:203-379-7328
Mailing Address - Fax:
Practice Address - Street 1:8 SAW MILL LN
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1572
Practice Address - Country:US
Practice Address - Phone:203-379-7328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1306388566OtherNPPES