Provider Demographics
NPI:1942452362
Name:THREE K'S CARE TRANSPORTATION,INC
Entity Type:Organization
Organization Name:THREE K'S CARE TRANSPORTATION,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.P.N./C.E.O
Authorized Official - Prefix:MS
Authorized Official - First Name:QUEENA
Authorized Official - Middle Name:KOTU
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:763-544-3148
Mailing Address - Street 1:7600 BASS LAKE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3860
Mailing Address - Country:US
Mailing Address - Phone:763-544-3148
Mailing Address - Fax:763-544-3149
Practice Address - Street 1:7600 BASS LAKE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-3860
Practice Address - Country:US
Practice Address - Phone:763-544-3148
Practice Address - Fax:763-544-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS450711786890343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNMMedicaid