Provider Demographics
NPI:1376940031
Name:360 TRANSPORT LLC
Entity Type:Organization
Organization Name:360 TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-735-8156
Mailing Address - Street 1:14855 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:DRAKES BRANCH
Mailing Address - State:VA
Mailing Address - Zip Code:23937-2526
Mailing Address - Country:US
Mailing Address - Phone:434-735-8156
Mailing Address - Fax:434-735-8157
Practice Address - Street 1:14855 KINGS HWY
Practice Address - Street 2:
Practice Address - City:DRAKES BRANCH
Practice Address - State:VA
Practice Address - Zip Code:23937-2526
Practice Address - Country:US
Practice Address - Phone:434-735-8156
Practice Address - Fax:434-735-8157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)