Provider Demographics
NPI:1083128979
Name:RED DOOR TRANSPORTATION
Entity Type:Organization
Organization Name:RED DOOR TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-398-5419
Mailing Address - Street 1:7241 S LUELLA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2513
Mailing Address - Country:US
Mailing Address - Phone:773-398-5419
Mailing Address - Fax:773-834-1351
Practice Address - Street 1:7241 S LUELLA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2513
Practice Address - Country:US
Practice Address - Phone:773-398-5419
Practice Address - Fax:773-834-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)