Provider Demographics
NPI:1093349441
Name:CENTRAL CITRUS TRANSPORT LLC
Entity Type:Organization
Organization Name:CENTRAL CITRUS TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:RAHMON
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:407-202-6969
Mailing Address - Street 1:11563 AMIDSHIP LN UNIT 8209
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5537
Mailing Address - Country:US
Mailing Address - Phone:407-202-6969
Mailing Address - Fax:
Practice Address - Street 1:11563 AMIDSHIP LN UNIT 8209
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5537
Practice Address - Country:US
Practice Address - Phone:407-202-6969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)