Provider Demographics
NPI:1336830884
Name:GLITZY LLC
Entity Type:Organization
Organization Name:GLITZY LLC
Other - Org Name:FENIX TRANSPORTATION SERVICES NC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESPO-BRITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-835-1001
Mailing Address - Street 1:3034 STODDERT LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4512
Mailing Address - Country:US
Mailing Address - Phone:910-835-1001
Mailing Address - Fax:
Practice Address - Street 1:3034 STODDERT LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4512
Practice Address - Country:US
Practice Address - Phone:910-391-4698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle