Provider Demographics
NPI:1841164902
Name:LAKEBOUND TRANSPORTATION LLC
Entity type:Organization
Organization Name:LAKEBOUND TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAFII
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-436-0384
Mailing Address - Street 1:1575 SARAZIN ST APT 115
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2587
Mailing Address - Country:US
Mailing Address - Phone:716-436-0384
Mailing Address - Fax:
Practice Address - Street 1:1575 SARAZIN ST APT 115
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2587
Practice Address - Country:US
Practice Address - Phone:716-436-0384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)