NPI 1306792601

Family 1579 LLC.

Organisation Supports Brokerage Agency Indiana, PA

Practice location

Address: 420 Oak St, Indiana, PA 15701-1934
Phone: (724) 464-4641

Authorised official

Name: Michael Booth
Title: Owner
Phone: (724) 464-4641

Registered specialties

Supports Brokerage Agency Primary

Agencies Taxonomy 251X00000X

Other Supports Brokerage providers in Pennsylvania →

Registry record

NPI: 1306792601
Entity type: Organization
NPI issued: 9 Mar 2026
Record last updated: 9 Mar 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.