Provider Demographics
NPI:1407117591
Name:TA TRANSPORT HOLDINGS, LLC
Entity Type:Organization
Organization Name:TA TRANSPORT HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY, TRESURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SPIRO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:818-266-4416
Mailing Address - Street 1:655 N CENTRAL AVE
Mailing Address - Street 2:17TH FLOOR
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1422
Mailing Address - Country:US
Mailing Address - Phone:626-683-7555
Mailing Address - Fax:
Practice Address - Street 1:1300 GARDENA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2726
Practice Address - Country:US
Practice Address - Phone:818-265-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL STONE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport