Provider Demographics
NPI:1366847741
Name:IMMEDIATECARE TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:IMMEDIATECARE TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMEDWELI
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-432-5637
Mailing Address - Street 1:710 40TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2901
Mailing Address - Country:US
Mailing Address - Phone:763-432-5637
Mailing Address - Fax:763-432-3866
Practice Address - Street 1:710 40TH AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2901
Practice Address - Country:US
Practice Address - Phone:763-432-5637
Practice Address - Fax:763-432-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)