Provider Demographics
NPI:1417217423
Name:REGENCY TRANSPORTATION LLC
Entity Type:Organization
Organization Name:REGENCY TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-799-2555
Mailing Address - Street 1:4300 SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2957
Mailing Address - Country:US
Mailing Address - Phone:313-799-2555
Mailing Address - Fax:313-291-9108
Practice Address - Street 1:4300 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2957
Practice Address - Country:US
Practice Address - Phone:313-799-2555
Practice Address - Fax:313-291-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2642343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)