Provider Demographics
NPI:1265197024
Name:A RAE OF LIGHT TRANSPORTATION, LLC
Entity type:Organization
Organization Name:A RAE OF LIGHT TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-319-4565
Mailing Address - Street 1:PO BOX 2680
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70054-2680
Mailing Address - Country:US
Mailing Address - Phone:504-319-4565
Mailing Address - Fax:
Practice Address - Street 1:3817 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-1106
Practice Address - Country:US
Practice Address - Phone:504-319-4656
Practice Address - Fax:504-319-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)