Provider Demographics
NPI:1801366786
Name:ROLE MODEL VISION LLC
Entity Type:Organization
Organization Name:ROLE MODEL VISION LLC
Other - Org Name:ROLE MODEL VISION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:RELEFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-984-6038
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-3276
Mailing Address - Country:US
Mailing Address - Phone:404-984-6038
Mailing Address - Fax:
Practice Address - Street 1:2121 S HIAWASSEE RD APT 4624
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8768
Practice Address - Country:US
Practice Address - Phone:404-984-6038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)