Provider Demographics
NPI:1891305389
Name:LEAF TRANSPORATION COMPANY
Entity Type:Organization
Organization Name:LEAF TRANSPORATION COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MORTRICE
Authorized Official - Middle Name:TYRESSE
Authorized Official - Last Name:LEAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-468-3555
Mailing Address - Street 1:PO BOX 13721
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29504-3721
Mailing Address - Country:US
Mailing Address - Phone:843-468-3555
Mailing Address - Fax:
Practice Address - Street 1:2724 BOARDWALK
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6651
Practice Address - Country:US
Practice Address - Phone:843-468-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)