Provider Demographics
NPI:1790439990
Name:LOGAN VALLEY TRANSPORTATION LLC
Entity Type:Organization
Organization Name:LOGAN VALLEY TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-205-9233
Mailing Address - Street 1:9328 CERULEAN DR APT 301
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4775
Mailing Address - Country:US
Mailing Address - Phone:267-205-9233
Mailing Address - Fax:
Practice Address - Street 1:9328 CERULEAN DR APT 301
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4775
Practice Address - Country:US
Practice Address - Phone:267-205-9233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)