Provider Demographics
NPI:1649068719
Name:CARMALITA TRANSPORT SERVICE; LLC
Entity type:Organization
Organization Name:CARMALITA TRANSPORT SERVICE; LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMALITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GENDRAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-704-6640
Mailing Address - Street 1:38360 TAMARAC BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8115
Mailing Address - Country:US
Mailing Address - Phone:216-704-6640
Mailing Address - Fax:216-704-6640
Practice Address - Street 1:38360 TAMARAC BLVD APT 101
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-8115
Practice Address - Country:US
Practice Address - Phone:216-704-6640
Practice Address - Fax:216-704-6640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty