Provider Demographics
NPI:1871848580
Name:SACRED SUN TRANSPORT
Entity Type:Organization
Organization Name:SACRED SUN TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEORY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-810-2202
Mailing Address - Street 1:PO BOX 2947
Mailing Address - Street 2:
Mailing Address - City:WINDOW ROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86515
Mailing Address - Country:US
Mailing Address - Phone:928-810-2202
Mailing Address - Fax:928-810-2204
Practice Address - Street 1:1/4 MILE N. DENNY'S ON OLD TOWN STORY RD.
Practice Address - Street 2:
Practice Address - City:ST. MICHAELS
Practice Address - State:AZ
Practice Address - Zip Code:86511
Practice Address - Country:US
Practice Address - Phone:928-810-2204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ683547343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)