Provider Demographics
NPI:1578702742
Name:SAFEWAYLUXURYTRANSPORTATION L.L.C.
Entity Type:Organization
Organization Name:SAFEWAYLUXURYTRANSPORTATION L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:RASSIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-799-5500
Mailing Address - Street 1:646 SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1430
Mailing Address - Country:US
Mailing Address - Phone:508-799-5500
Mailing Address - Fax:508-799-5505
Practice Address - Street 1:646 SALISBURY ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1430
Practice Address - Country:US
Practice Address - Phone:508-799-5500
Practice Address - Fax:508-799-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000943003343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1719335Medicaid