Provider Demographics
NPI:1053846717
Name:COMMUNITY TRANSPORTATION LLC
Entity Type:Organization
Organization Name:COMMUNITY TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:347-321-1156
Mailing Address - Street 1:79 YAUN AVE APT 15
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-1640
Mailing Address - Country:US
Mailing Address - Phone:845-747-9138
Mailing Address - Fax:845-236-5634
Practice Address - Street 1:79 YAUN AVE APT 15
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1640
Practice Address - Country:US
Practice Address - Phone:845-747-9138
Practice Address - Fax:845-236-5634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY522327484344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03642046Medicaid