Provider Demographics
NPI:1205460623
Name:GRO MADANM ENTERPRISE LLC
Entity type:Organization
Organization Name:GRO MADANM ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OTNIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFRANC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-364-9928
Mailing Address - Street 1:4377 COMMERCIAL WAY # 103
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10730 N 56TH ST STE 204
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3611
Practice Address - Country:US
Practice Address - Phone:813-364-9928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker