Provider Demographics
NPI:1811557945
Name:REALM TRANSPORT INC.
Entity Type:Organization
Organization Name:REALM TRANSPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-243-2979
Mailing Address - Street 1:14765 MANZANO RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-9207
Mailing Address - Country:US
Mailing Address - Phone:760-243-2979
Mailing Address - Fax:
Practice Address - Street 1:14765 MANZANO RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-9207
Practice Address - Country:US
Practice Address - Phone:760-243-2979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REALM TRANSPORT INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle