Provider Demographics
NPI:1033880125
Name:YOUR DESTINATION TRANSPORT CO LLC
Entity Type:Organization
Organization Name:YOUR DESTINATION TRANSPORT CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDIE
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-264-3235
Mailing Address - Street 1:1196 WOLF SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-9510
Mailing Address - Country:US
Mailing Address - Phone:910-264-3235
Mailing Address - Fax:
Practice Address - Street 1:1196 WOLF SWAMP RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-9510
Practice Address - Country:US
Practice Address - Phone:910-264-3235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle