Provider Demographics
NPI:1972117604
Name:LACEY RUNIT, INC
Entity Type:Organization
Organization Name:LACEY RUNIT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGAR
Authorized Official - Prefix:
Authorized Official - First Name:LORAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-288-0679
Mailing Address - Street 1:3759 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-3919
Mailing Address - Country:US
Mailing Address - Phone:190-128-8067
Mailing Address - Fax:901-249-3391
Practice Address - Street 1:3759 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-3919
Practice Address - Country:US
Practice Address - Phone:901-288-0679
Practice Address - Fax:901-249-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)