Provider Demographics
NPI:1134603871
Name:ANY OL' TIME TRANSPORTATION LLC
Entity type:Organization
Organization Name:ANY OL' TIME TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:RHINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-288-7493
Mailing Address - Street 1:3325 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-9505
Mailing Address - Country:US
Mailing Address - Phone:231-225-0441
Mailing Address - Fax:231-225-4209
Practice Address - Street 1:3325 5TH ST
Practice Address - Street 2:
Practice Address - City:TWIN LAKE
Practice Address - State:MI
Practice Address - Zip Code:49457-9505
Practice Address - Country:US
Practice Address - Phone:231-225-0441
Practice Address - Fax:231-225-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI802215238OtherLARA