Provider Demographics
NPI:1205385895
Name:DOOR TO DOOR TRANSPORT SERVICES, LLC
Entity Type:Organization
Organization Name:DOOR TO DOOR TRANSPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-577-2509
Mailing Address - Street 1:2996 N GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1052
Mailing Address - Country:US
Mailing Address - Phone:315-577-2509
Mailing Address - Fax:
Practice Address - Street 1:2996 N GENESEE ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1052
Practice Address - Country:US
Practice Address - Phone:315-577-2509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03834677Medicaid