Provider Demographics
NPI:1831484070
Name:SAFEWAY TRANSPORTATION INC
Entity Type:Organization
Organization Name:SAFEWAY TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RABON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-405-4013
Mailing Address - Street 1:8648 N 53RD ST
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-3010
Mailing Address - Country:US
Mailing Address - Phone:414-264-9455
Mailing Address - Fax:414-264-4646
Practice Address - Street 1:8648 N 53RD ST
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-3010
Practice Address - Country:US
Practice Address - Phone:414-264-9455
Practice Address - Fax:414-264-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI347E00000X347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41483000Medicaid