Provider Demographics
NPI:1114567104
Name:VISIT VANS LLC
Entity Type:Organization
Organization Name:VISIT VANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHALANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-294-7655
Mailing Address - Street 1:1101 HAMILTON ST STE 160
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18101-1043
Mailing Address - Country:US
Mailing Address - Phone:484-550-6388
Mailing Address - Fax:484-498-2420
Practice Address - Street 1:1101 HAMILTON ST STE 160
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-1043
Practice Address - Country:US
Practice Address - Phone:484-550-6388
Practice Address - Fax:484-498-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)