Provider Demographics
NPI:1265098115
Name:EXODUS TRANSPORT, LLC
Entity type:Organization
Organization Name:EXODUS TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-475-5416
Mailing Address - Street 1:7124 FOREST HILL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1541
Mailing Address - Country:US
Mailing Address - Phone:804-269-4881
Mailing Address - Fax:804-726-6251
Practice Address - Street 1:7124 FOREST HILL AVE STE D
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1541
Practice Address - Country:US
Practice Address - Phone:804-269-4881
Practice Address - Fax:804-726-6251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
12111961Other12111961