Provider Demographics
NPI:1134977002
Name:FUTURE SELF LOGISTICS LLC
Entity type:Organization
Organization Name:FUTURE SELF LOGISTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-505-6342
Mailing Address - Street 1:5011 GATE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0830
Mailing Address - Country:US
Mailing Address - Phone:904-505-6342
Mailing Address - Fax:
Practice Address - Street 1:5011 GATE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0830
Practice Address - Country:US
Practice Address - Phone:904-505-6342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)