Provider Demographics
NPI:1851122923
Name:EASTSIDE TRANSPORTATION OF MICHIGAN LLC
Entity type:Organization
Organization Name:EASTSIDE TRANSPORTATION OF MICHIGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KEZZIE
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:GASEITSIWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:531-262-8379
Mailing Address - Street 1:1025 GOODHUE BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-4351
Mailing Address - Country:US
Mailing Address - Phone:531-289-9774
Mailing Address - Fax:
Practice Address - Street 1:1025 GOODHUE BLVD APT B
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-4351
Practice Address - Country:US
Practice Address - Phone:531-289-9774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)