Provider Demographics
NPI:1750034674
Name:LITTLE TOWN, LLC
Entity Type:Organization
Organization Name:LITTLE TOWN, LLC
Other - Org Name:GRACE TRANSITIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-850-5563
Mailing Address - Street 1:40125 10TH ST W UNIT R-S
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3019
Mailing Address - Country:US
Mailing Address - Phone:313-850-5663
Mailing Address - Fax:
Practice Address - Street 1:40125 10TH ST W STE U
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3035
Practice Address - Country:US
Practice Address - Phone:313-850-5663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)