Provider Demographics
NPI:1891180527
Name:SAFEWAY PASSAGE
Entity Type:Organization
Organization Name:SAFEWAY PASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GP
Authorized Official - Prefix:
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LINARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-930-6172
Mailing Address - Street 1:3702 MALBON WAY
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-7800
Mailing Address - Country:US
Mailing Address - Phone:804-833-1383
Mailing Address - Fax:
Practice Address - Street 1:8012 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5232
Practice Address - Country:US
Practice Address - Phone:804-833-1383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1296078343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)