Provider Demographics
NPI:1245680198
Name:GREEN ZONE TRANSPORTATION
Entity type:Organization
Organization Name:GREEN ZONE TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TODOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-800-8437
Mailing Address - Street 1:119 S VALLEY DR
Mailing Address - Street 2:SUITE A123
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2974
Mailing Address - Country:US
Mailing Address - Phone:208-800-8437
Mailing Address - Fax:
Practice Address - Street 1:119 S VALLEY DR
Practice Address - Street 2:SUITE A123
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2974
Practice Address - Country:US
Practice Address - Phone:208-800-8437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD186444343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)