Provider Demographics
NPI:1295365013
Name:CENTRAL TRANSPORT SERVICES OF CLEVELAND COUNTY, INC
Entity type:Organization
Organization Name:CENTRAL TRANSPORT SERVICES OF CLEVELAND COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:LAVELLE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-300-2981
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:EARL
Mailing Address - State:NC
Mailing Address - Zip Code:28038-0483
Mailing Address - Country:US
Mailing Address - Phone:704-300-2981
Mailing Address - Fax:
Practice Address - Street 1:109 HEINZ DRIVE
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:NC
Practice Address - Zip Code:28073
Practice Address - Country:US
Practice Address - Phone:704-300-2981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)