Provider Demographics
NPI:1750672150
Name:ACTIVE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:ACTIVE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKLITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-818-7474
Mailing Address - Street 1:50 BAKER BLVD STE 6A
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3603
Mailing Address - Country:US
Mailing Address - Phone:330-818-7474
Mailing Address - Fax:330-869-6366
Practice Address - Street 1:50 BAKER BLVD STE 6A
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3603
Practice Address - Country:US
Practice Address - Phone:330-818-7474
Practice Address - Fax:330-869-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPHC5325343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)