Provider Demographics
NPI:1760742902
Name:DINEH TRANSPORT LLC
Entity Type:Organization
Organization Name:DINEH TRANSPORT LLC
Other - Org Name:SMOKE SIGNAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-725-3960
Mailing Address - Street 1:PO BOX 4253
Mailing Address - Street 2:
Mailing Address - City:BLUE GAP
Mailing Address - State:AZ
Mailing Address - Zip Code:86520-4253
Mailing Address - Country:US
Mailing Address - Phone:928-725-3960
Mailing Address - Fax:928-725-2056
Practice Address - Street 1:NORTH OF NAVAJO ROUTE 673
Practice Address - Street 2:
Practice Address - City:BLUE GAP
Practice Address - State:AZ
Practice Address - Zip Code:86520-4253
Practice Address - Country:US
Practice Address - Phone:928-725-3960
Practice Address - Fax:928-725-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL14588250347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ351068Medicaid