Provider Demographics
NPI:1497064976
Name:ANISA'S TRANSPORTATION VAN SERVICES
Entity Type:Organization
Organization Name:ANISA'S TRANSPORTATION VAN SERVICES
Other - Org Name:ANISA'S HOME ASSISTED LIVING LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESKA
Authorized Official - Middle Name:PELAUR
Authorized Official - Last Name:LEE
Authorized Official - Suffix:I
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:443-500-9861
Mailing Address - Street 1:7311 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-1233
Mailing Address - Country:US
Mailing Address - Phone:443-500-9861
Mailing Address - Fax:410-668-1959
Practice Address - Street 1:7311 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-1233
Practice Address - Country:US
Practice Address - Phone:443-500-9861
Practice Address - Fax:410-668-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL-000-789-680-148343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherASSISTED LIVING/ VAN SERVICE