Provider Demographics
NPI:1982192415
Name:ROYAL CROWN TRANS LLC
Entity Type:Organization
Organization Name:ROYAL CROWN TRANS LLC
Other - Org Name:ROYAL CROWN TRANS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARMAKE
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:MOHAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-218-9817
Mailing Address - Street 1:5401 E VAN BUREN ST UNIT 3054
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-3469
Mailing Address - Country:US
Mailing Address - Phone:832-209-0360
Mailing Address - Fax:
Practice Address - Street 1:213 W MESA AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-6335
Practice Address - Country:US
Practice Address - Phone:614-218-9817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5657164343900000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)