Provider Demographics
NPI:1508262981
Name:FANCEE LIMOUSINE SERVICE, INC
Entity Type:Organization
Organization Name:FANCEE LIMOUSINE SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:DAVERSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-483-3661
Mailing Address - Street 1:3955 DRY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:FALCONER
Mailing Address - State:NY
Mailing Address - Zip Code:14733-9795
Mailing Address - Country:US
Mailing Address - Phone:716-483-3661
Mailing Address - Fax:716-665-2893
Practice Address - Street 1:3955 DRY BROOK RD
Practice Address - Street 2:
Practice Address - City:FALCONER
Practice Address - State:NY
Practice Address - Zip Code:14733-9795
Practice Address - Country:US
Practice Address - Phone:716-483-3661
Practice Address - Fax:716-665-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03236995Medicaid