Provider Demographics
NPI:1689362956
Name:HUCKLEBERRY TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:HUCKLEBERRY TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-357-0277
Mailing Address - Street 1:520 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-3218
Mailing Address - Country:US
Mailing Address - Phone:707-357-0277
Mailing Address - Fax:
Practice Address - Street 1:520 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3218
Practice Address - Country:US
Practice Address - Phone:707-357-0277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)