Provider Demographics
NPI:1710758974
Name:GRAND CANYON TRANSPORTATION
Entity Type:Organization
Organization Name:GRAND CANYON TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:N
Authorized Official - Last Name:HARGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-370-6365
Mailing Address - Street 1:5852 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-6708
Mailing Address - Country:US
Mailing Address - Phone:520-370-6365
Mailing Address - Fax:
Practice Address - Street 1:5852 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-6708
Practice Address - Country:US
Practice Address - Phone:520-370-6365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle