Provider Demographics
NPI:1275159154
Name:RECONNECT TRANSPORTATION SERVICES LLC
Entity Type:Organization
Organization Name:RECONNECT TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-596-8750
Mailing Address - Street 1:11501 HIGHLAND FARM CT
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-3301
Mailing Address - Country:US
Mailing Address - Phone:240-718-8595
Mailing Address - Fax:
Practice Address - Street 1:11501 HIGHLAND FARM CT
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-3301
Practice Address - Country:US
Practice Address - Phone:240-718-8595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)