Provider Demographics
NPI:1477985125
Name:GREAT LAKES SHUTTLE COMPANY, LLC
Entity Type:Organization
Organization Name:GREAT LAKES SHUTTLE COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-642-7433
Mailing Address - Street 1:41800 HAYES RD
Mailing Address - Street 2:SUITE 527
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1876
Mailing Address - Country:US
Mailing Address - Phone:855-642-7433
Mailing Address - Fax:
Practice Address - Street 1:41800 HAYES RD
Practice Address - Street 2:SUITE 527
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1876
Practice Address - Country:US
Practice Address - Phone:855-642-7433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle