Provider Demographics
NPI:1891407946
Name:LIGHT WAY TRANSPORT LLC
Entity Type:Organization
Organization Name:LIGHT WAY TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIZIGIYIMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIFODI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-445-2575
Mailing Address - Street 1:1422 NE POLK DR
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-2370
Mailing Address - Country:US
Mailing Address - Phone:571-445-2575
Mailing Address - Fax:
Practice Address - Street 1:1422 NE POLK DR
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-2370
Practice Address - Country:US
Practice Address - Phone:571-445-2575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)