Provider Demographics
NPI:1619465085
Name:CLASSY CADDY, LLC
Entity Type:Organization
Organization Name:CLASSY CADDY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICKI
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-455-4084
Mailing Address - Street 1:22 E WILT AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-2936
Mailing Address - Country:US
Mailing Address - Phone:352-589-5113
Mailing Address - Fax:352-589-7320
Practice Address - Street 1:22 E WILT AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2936
Practice Address - Country:US
Practice Address - Phone:352-589-5113
Practice Address - Fax:352-589-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherNEMT