Provider Demographics
NPI:1437487642
Name:A PUGET SOUND CABULANCE SERVICE LLC
Entity Type:Organization
Organization Name:A PUGET SOUND CABULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-365-3121
Mailing Address - Street 1:13319 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3006
Mailing Address - Country:US
Mailing Address - Phone:206-365-3121
Mailing Address - Fax:206-365-0253
Practice Address - Street 1:13319 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-3006
Practice Address - Country:US
Practice Address - Phone:206-365-3121
Practice Address - Fax:206-365-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-28
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAB11022C343900000X
WAB11021C343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)