Provider Demographics
NPI:1295022085
Name:RELIANT SHUTTLE
Entity Type:Organization
Organization Name:RELIANT SHUTTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SELORM
Authorized Official - Middle Name:KWAKU
Authorized Official - Last Name:ATIEDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-675-7889
Mailing Address - Street 1:4436 CORTE ARBUSTO
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-4048
Mailing Address - Country:US
Mailing Address - Phone:818-675-7889
Mailing Address - Fax:
Practice Address - Street 1:4436 CORTE ARBUSTO
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-4048
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:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)