Provider Demographics
NPI:1043319775
Name:VAN ENTERPRISES, INC.
Entity Type:Organization
Organization Name:VAN ENTERPRISES, INC.
Other - Org Name:DBA APPLE LANE AMBULETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN ORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-522-9904
Mailing Address - Street 1:672 SPRINGMILL ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-1106
Mailing Address - Country:US
Mailing Address - Phone:419-522-9904
Mailing Address - Fax:419-522-6240
Practice Address - Street 1:672 SPRINGMILL ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-1106
Practice Address - Country:US
Practice Address - Phone:419-522-9904
Practice Address - Fax:419-522-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH705055343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0953517Medicaid