Provider Demographics
NPI:1306203146
Name:BOLAT INCORPORATED
Entity Type:Organization
Organization Name:BOLAT INCORPORATED
Other - Org Name:BETHEL CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OMOLOLU
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-205-9809
Mailing Address - Street 1:7070 UPPER 157TH ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5121
Mailing Address - Country:US
Mailing Address - Phone:651-207-5290
Mailing Address - Fax:651-330-4795
Practice Address - Street 1:1959 SHAWNEE RD STE 215
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1220
Practice Address - Country:US
Practice Address - Phone:651-207-5290
Practice Address - Fax:651-330-4795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle