Provider Demographics
NPI:1003121179
Name:FOREVER YOUNG MEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:FOREVER YOUNG MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:GATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-235-3473
Mailing Address - Street 1:4675 E 153RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-3014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4675 E 153RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-3014
Practice Address - Country:US
Practice Address - Phone:216-235-3473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOREVER YOUNG TRANSPORTATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)