Provider Demographics
NPI:1578876546
Name:JOHNRE LLC
Entity Type:Organization
Organization Name:JOHNRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SICAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-780-5348
Mailing Address - Street 1:16162 PONDEROSA LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-6155
Mailing Address - Country:US
Mailing Address - Phone:951-318-7352
Mailing Address - Fax:951-658-5263
Practice Address - Street 1:16162 PONDEROSA LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-6155
Practice Address - Country:US
Practice Address - Phone:951-318-7352
Practice Address - Fax:951-658-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)