Provider Demographics
NPI:1174047435
Name:OPEN DOOR MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:OPEN DOOR MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:LOSENICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-203-2383
Mailing Address - Street 1:818 EQUINOX LOOP
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2984
Mailing Address - Country:US
Mailing Address - Phone:916-203-2383
Mailing Address - Fax:
Practice Address - Street 1:818 EQUINOX LOOP
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-2984
Practice Address - Country:US
Practice Address - Phone:916-203-2383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)