Provider Demographics
NPI:1245067503
Name:ACTIVE TRANSPORTATION SERVICES LLC
Entity type:Organization
Organization Name:ACTIVE TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSPORTATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOFOBA
Authorized Official - Middle Name:MUSA
Authorized Official - Last Name:KANNEH
Authorized Official - Suffix:
Authorized Official - Credentials:MOFOBA MUSA KANNEH
Authorized Official - Phone:612-876-2440
Mailing Address - Street 1:3815 BURQUEST LN
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3028
Mailing Address - Country:US
Mailing Address - Phone:612-876-2440
Mailing Address - Fax:
Practice Address - Street 1:3815 BURQUEST LN
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3028
Practice Address - Country:US
Practice Address - Phone:612-876-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle