Provider Demographics
NPI:1003073453
Name:DEDICATED NON-EMERGENCY TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:DEDICATED NON-EMERGENCY TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARDALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-831-3009
Mailing Address - Street 1:2381 WALKERS GLEN LN
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-9205
Mailing Address - Country:US
Mailing Address - Phone:770-831-3009
Mailing Address - Fax:678-278-0944
Practice Address - Street 1:2381 WALKERS GLEN LN
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-9205
Practice Address - Country:US
Practice Address - Phone:770-831-3009
Practice Address - Fax:678-278-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2008018597343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)