Provider Demographics
NPI:1821414319
Name:WANDA LEE
Entity Type:Organization
Organization Name:WANDA LEE
Other - Org Name:JR TRANSIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:304-960-9348
Mailing Address - Street 1:303 LOW GAP RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2530
Mailing Address - Country:US
Mailing Address - Phone:304-960-9348
Mailing Address - Fax:304-431-3198
Practice Address - Street 1:303 LOW GAP RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2530
Practice Address - Country:US
Practice Address - Phone:304-960-9348
Practice Address - Fax:304-431-3198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-09
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home