Provider Demographics
NPI:1619217882
Name:BERNICES GRANDDAUGHTER INC
Entity Type:Organization
Organization Name:BERNICES GRANDDAUGHTER INC
Other - Org Name:BERNIC'S GRANDDAUGHTER TRANSPORTATION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KONTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-751-5272
Mailing Address - Street 1:78B EMERAUDE PLAGE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4941
Mailing Address - Country:US
Mailing Address - Phone:757-751-5272
Mailing Address - Fax:
Practice Address - Street 1:78B EMERAUDE PLAGE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4941
Practice Address - Country:US
Practice Address - Phone:757-751-5272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA121243343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)