Provider Demographics
NPI:1497260848
Name:EXECUTIVE 2000 TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:EXECUTIVE 2000 TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOYFUL
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:SELAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-635-8555
Mailing Address - Street 1:11 ALCAP RDG STE D
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1036
Mailing Address - Country:US
Mailing Address - Phone:860-635-8555
Mailing Address - Fax:860-632-5163
Practice Address - Street 1:11 ALCAP RDG STE D
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1036
Practice Address - Country:US
Practice Address - Phone:860-635-8555
Practice Address - Fax:860-632-5163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi