Provider Demographics
NPI:1245786763
Name:LRHA TRANSPORTATION LLC
Entity Type:Organization
Organization Name:LRHA TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:FISSEHATSION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-457-5897
Mailing Address - Street 1:1923 COVINGTON LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2684
Mailing Address - Country:US
Mailing Address - Phone:952-457-5897
Mailing Address - Fax:
Practice Address - Street 1:1923 COVINGTON LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2684
Practice Address - Country:US
Practice Address - Phone:952-457-5897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNW603262567309343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)