Provider Demographics
NPI:1225629058
Name:GREENLINE NON-EMERGENCY MEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:GREENLINE NON-EMERGENCY MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-435-3239
Mailing Address - Street 1:360 N PACIFIC COAST HWY STE 2000
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4532
Mailing Address - Country:US
Mailing Address - Phone:323-849-9809
Mailing Address - Fax:
Practice Address - Street 1:360 N PACIFIC COAST HWY STE 2000
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4532
Practice Address - Country:US
Practice Address - Phone:323-849-9809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)