Provider Demographics
NPI:1821562463
Name:MISSION DRIVEN TRANSPORTATION INC
Entity Type:Organization
Organization Name:MISSION DRIVEN TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-362-8960
Mailing Address - Street 1:18020 MICHAEL AVE
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-5022
Mailing Address - Country:US
Mailing Address - Phone:630-465-5704
Mailing Address - Fax:
Practice Address - Street 1:18020 MICHAEL AVE
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-5022
Practice Address - Country:US
Practice Address - Phone:630-465-5704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No344600000XTransportation ServicesTaxi
No347B00000XTransportation ServicesBus
No347C00000XTransportation ServicesPrivate Vehicle