Provider Demographics
NPI:1336310937
Name:MAD VENTURES INC.
Entity Type:Organization
Organization Name:MAD VENTURES INC.
Other - Org Name:LEGACY TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:260-927-5131
Mailing Address - Street 1:1006 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-1142
Mailing Address - Country:US
Mailing Address - Phone:260-927-5131
Mailing Address - Fax:260-925-5308
Practice Address - Street 1:1006 N VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-1142
Practice Address - Country:US
Practice Address - Phone:260-927-5131
Practice Address - Fax:260-925-5308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)