Provider Demographics
NPI:1790953834
Name:RITA LOUISE PALMER
Entity Type:Organization
Organization Name:RITA LOUISE PALMER
Other - Org Name:FAITHFUL TRANSPORTATION L. L. C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-605-0555
Mailing Address - Street 1:PO BOX 4128
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-0128
Mailing Address - Country:US
Mailing Address - Phone:313-605-0555
Mailing Address - Fax:313-846-6889
Practice Address - Street 1:8210 COYLE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-2451
Practice Address - Country:US
Practice Address - Phone:313-605-0555
Practice Address - Fax:313-846-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIP456738549356343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)