Provider Demographics
NPI:1164607289
Name:ABA MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:ABA MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABODOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-881-8325
Mailing Address - Street 1:1254 S WATERMAN AVE STE 40
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2858
Mailing Address - Country:US
Mailing Address - Phone:909-881-8325
Mailing Address - Fax:909-881-6045
Practice Address - Street 1:1254 S WATERMAN AVE STE 40
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2858
Practice Address - Country:US
Practice Address - Phone:909-881-8325
Practice Address - Fax:909-881-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN