Provider Demographics
NPI:1427581735
Name:SHUTTLE UP TRANSPORTATION SERVICES LLC
Entity Type:Organization
Organization Name:SHUTTLE UP TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BREONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-261-1085
Mailing Address - Street 1:230 ELRUTH CT APT 96
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-3024
Mailing Address - Country:US
Mailing Address - Phone:330-261-1085
Mailing Address - Fax:
Practice Address - Street 1:230 ELRUTH CT APT 96
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-3024
Practice Address - Country:US
Practice Address - Phone:330-261-1085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)