Provider Demographics
NPI:1073149910
Name:TWO COUSINS TRANSPORTATION LLC,
Entity Type:Organization
Organization Name:TWO COUSINS TRANSPORTATION LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEJUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-239-4461
Mailing Address - Street 1:846 WOODLAND HILLS DR APT 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-3300
Mailing Address - Country:US
Mailing Address - Phone:601-416-8675
Mailing Address - Fax:
Practice Address - Street 1:846 WOODLAND HILLS DR APT 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-3300
Practice Address - Country:US
Practice Address - Phone:601-416-8675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-22
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi