Provider Demographics
NPI:1083146229
Name:TRANSPORTATION PROVIDER NETWORK LLC
Entity Type:Organization
Organization Name:TRANSPORTATION PROVIDER NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOUELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-236-5353
Mailing Address - Street 1:18269 APPOLINE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1451
Mailing Address - Country:US
Mailing Address - Phone:248-236-5353
Mailing Address - Fax:
Practice Address - Street 1:18269 APPOLINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1451
Practice Address - Country:US
Practice Address - Phone:248-236-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL10727343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)