Provider Demographics
NPI:1841430584
Name:STATE TO STATE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:STATE TO STATE TRANSPORTATION LLC
Other - Org Name:STATE TO STATE INVESTORS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-820-3853
Mailing Address - Street 1:2515 EAST 64TH #5
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104
Mailing Address - Country:US
Mailing Address - Phone:216-820-3853
Mailing Address - Fax:
Practice Address - Street 1:2515 E 64TH ST APT 5
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-1738
Practice Address - Country:US
Practice Address - Phone:216-820-3853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRJ806782343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)