Provider Demographics
NPI:1205658887
Name:OMOBA LUXURY TRANSIT LLC
Entity type:Organization
Organization Name:OMOBA LUXURY TRANSIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ONORIODE
Authorized Official - Middle Name:OMOBA
Authorized Official - Last Name:AUDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-890-1006
Mailing Address - Street 1:16110 WOODLAWN EAST AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1852
Mailing Address - Country:US
Mailing Address - Phone:312-890-1006
Mailing Address - Fax:
Practice Address - Street 1:16110 WOODLAWN EAST AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1852
Practice Address - Country:US
Practice Address - Phone:312-890-1006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)