Provider Demographics
NPI:1982193165
Name:PROVIDENCE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:PROVIDENCE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:JAMAL
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-560-0253
Mailing Address - Street 1:3800 CAMP CREEK PKWY SW BLDG 1400-116
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-6045
Mailing Address - Country:US
Mailing Address - Phone:504-418-1117
Mailing Address - Fax:
Practice Address - Street 1:3800 CAMP CREEK PKWY SW BLDG 1400-116 SUITE 2287
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-6045
Practice Address - Country:US
Practice Address - Phone:800-560-0253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1982193165Medicaid
LA1982193165Medicaid