Provider Demographics
NPI:1760841183
Name:WOLLWALO TRANSIT LLC
Entity Type:Organization
Organization Name:WOLLWALO TRANSIT LLC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:ALEMAYO
Authorized Official - Last Name:WELDEMICHAEL
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:303-931-7186
Mailing Address - Street 1:1626 S CHESTER CT DENVER CO
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247
Mailing Address - Country:US
Mailing Address - Phone:303-931-7186
Mailing Address - Fax:
Practice Address - Street 1:1626 S CHESTER CT
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-3405
Practice Address - Country:US
Practice Address - Phone:303-931-7186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO062051082343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20151730858Medicaid