Provider Demographics
NPI:1013481365
Name:PBC TRANSPORTATION & HAULING LLC
Entity Type:Organization
Organization Name:PBC TRANSPORTATION & HAULING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:CLIFF
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DET, SUMMA CUM LAUDE
Authorized Official - Phone:216-334-0494
Mailing Address - Street 1:950 WHITBY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2348
Mailing Address - Country:US
Mailing Address - Phone:216-334-0494
Mailing Address - Fax:
Practice Address - Street 1:950 WHITBY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44112-2348
Practice Address - Country:US
Practice Address - Phone:216-334-0494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH46-1206184Medicaid