Provider Demographics
NPI:1750052361
Name:HOMEBASE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:HOMEBASE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKEA
Authorized Official - Middle Name:
Authorized Official - Last Name:ECCLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-806-0076
Mailing Address - Street 1:30 CANDLEWYCK CT APT 10
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2072
Mailing Address - Country:US
Mailing Address - Phone:276-690-7788
Mailing Address - Fax:
Practice Address - Street 1:30 CANDLEWYCK CT APT 10
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2072
Practice Address - Country:US
Practice Address - Phone:276-690-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)