Provider Demographics
NPI:1033756267
Name:LUCY TRANSPORT LLC
Entity Type:Organization
Organization Name:LUCY TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BINIAM
Authorized Official - Middle Name:HIRUT
Authorized Official - Last Name:DEBABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-715-7066
Mailing Address - Street 1:8453 BAUER DR APT 21
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-3907
Mailing Address - Country:US
Mailing Address - Phone:703-715-7066
Mailing Address - Fax:
Practice Address - Street 1:8453 BAUER DR APT 21
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-3907
Practice Address - Country:US
Practice Address - Phone:703-715-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)