Provider Demographics
NPI:1356599914
Name:VICTORY TRANSPORT NORTH
Entity type:Organization
Organization Name:VICTORY TRANSPORT NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRESCANCINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-413-1555
Mailing Address - Street 1:10907 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434
Mailing Address - Country:US
Mailing Address - Phone:763-413-1555
Mailing Address - Fax:763-413-1575
Practice Address - Street 1:10907 4TH ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434
Practice Address - Country:US
Practice Address - Phone:763-413-1555
Practice Address - Fax:763-413-1575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICTORY TRANSPORT NORTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374426343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)