Provider Demographics
NPI:1609421098
Name:SAFEWAY EXPRESS TRANSPORTATION LLC
Entity Type:Organization
Organization Name:SAFEWAY EXPRESS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAPONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-366-6232
Mailing Address - Street 1:722 E MARKET ST STE 102-V24
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3255
Mailing Address - Country:US
Mailing Address - Phone:301-366-6232
Mailing Address - Fax:
Practice Address - Street 1:722 E MARKET ST STE 102-V24
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3255
Practice Address - Country:US
Practice Address - Phone:301-366-6232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)