Provider Demographics
NPI:1922683739
Name:LATITUDE TRANSPORTATION INC
Entity Type:Organization
Organization Name:LATITUDE TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLASENOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-777-4919
Mailing Address - Street 1:2328 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2781
Mailing Address - Country:US
Mailing Address - Phone:708-777-4919
Mailing Address - Fax:
Practice Address - Street 1:2328 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2781
Practice Address - Country:US
Practice Address - Phone:708-777-4919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)