Provider Demographics
NPI:1396016366
Name:CITIES EDGE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:CITIES EDGE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SOCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-972-3753
Mailing Address - Street 1:8182 CALDER AVE SE
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8029
Mailing Address - Country:US
Mailing Address - Phone:763-972-3753
Mailing Address - Fax:800-418-4211
Practice Address - Street 1:8182 CALDER AVE SE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8029
Practice Address - Country:US
Practice Address - Phone:763-972-3753
Practice Address - Fax:800-418-4211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITIES EDGE TRANSPORTATION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNSTS 374966343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)