Provider Demographics
NPI:1407454325
Name:RICHWOOD ENTERPRISES LLC DBA RICHWOOD TRANSPORT
Entity Type:Organization
Organization Name:RICHWOOD ENTERPRISES LLC DBA RICHWOOD TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-279-7984
Mailing Address - Street 1:2564 BRANCH ST STE B10
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2850
Mailing Address - Country:US
Mailing Address - Phone:608-279-7984
Mailing Address - Fax:
Practice Address - Street 1:2564 BRANCH ST STE B10
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2850
Practice Address - Country:US
Practice Address - Phone:608-279-7984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100066029Medicaid