Provider Demographics
NPI:1235379835
Name:TRUST SHUTTLE
Entity Type:Organization
Organization Name:TRUST SHUTTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SELORM
Authorized Official - Middle Name:K
Authorized Official - Last Name:ATIEDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-675-7889
Mailing Address - Street 1:718 FOREST PARK BLVD APT 223
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-5405
Mailing Address - Country:US
Mailing Address - Phone:818-675-7889
Mailing Address - Fax:
Practice Address - Street 1:8652 THOMAS CHARLES LN
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-4103
Practice Address - Country:US
Practice Address - Phone:818-675-7889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)