Provider Demographics
NPI:1851551931
Name:MARKS FRIENDLY CAB
Entity Type:Organization
Organization Name:MARKS FRIENDLY CAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-236-1901
Mailing Address - Street 1:121 E SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4635
Mailing Address - Country:US
Mailing Address - Phone:765-236-1901
Mailing Address - Fax:765-236-1904
Practice Address - Street 1:121 E SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4635
Practice Address - Country:US
Practice Address - Phone:765-236-1901
Practice Address - Fax:765-236-1904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARKS FRIENDLY CAB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1740540343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)