Provider Demographics
NPI:1568009132
Name:LOYALTY FIRST TRANSPORTATION LLC
Entity Type:Organization
Organization Name:LOYALTY FIRST TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-314-9083
Mailing Address - Street 1:1840 S NELSON ST APT 45
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1437
Mailing Address - Country:US
Mailing Address - Phone:626-314-9083
Mailing Address - Fax:
Practice Address - Street 1:1840 S NELSON ST APT 45
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1437
Practice Address - Country:US
Practice Address - Phone:626-314-9083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOYALTY FIRST TRANSPORTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)