Provider Demographics
NPI:1760875959
Name:POSITIVE CHANGE TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:POSITIVE CHANGE TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:318-779-8527
Mailing Address - Street 1:6461 BUNCOMBE RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-4305
Mailing Address - Country:US
Mailing Address - Phone:318-688-8192
Mailing Address - Fax:318-688-8193
Practice Address - Street 1:348 W 79TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-4820
Practice Address - Country:US
Practice Address - Phone:318-688-8192
Practice Address - Fax:318-688-8193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)