Provider Demographics
NPI:1922711837
Name:SHASTA MOUNTAIN SHUTTLE AND TOURS LLC
Entity Type:Organization
Organization Name:SHASTA MOUNTAIN SHUTTLE AND TOURS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ELMER
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:530-859-1845
Mailing Address - Street 1:709 ROCKFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9405
Mailing Address - Country:US
Mailing Address - Phone:530-859-1845
Mailing Address - Fax:
Practice Address - Street 1:709 ROCKFELLOW DR
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-9405
Practice Address - Country:US
Practice Address - Phone:530-859-1845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)