Provider Demographics
NPI:1780005132
Name:CITIZENS CARE TRANS LLC
Entity Type:Organization
Organization Name:CITIZENS CARE TRANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALEH
Authorized Official - Middle Name:I
Authorized Official - Last Name:BAROUKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-456-1560
Mailing Address - Street 1:3113 W DESERT LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-3829
Mailing Address - Country:US
Mailing Address - Phone:336-456-1560
Mailing Address - Fax:
Practice Address - Street 1:3113 W DESERT LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-3829
Practice Address - Country:US
Practice Address - Phone:336-456-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL18808290343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)