Provider Demographics
NPI:1649784901
Name:LUCY TRANSPORTATION INC
Entity type:Organization
Organization Name:LUCY TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESEDANT
Authorized Official - Prefix:
Authorized Official - First Name:HABETAMU
Authorized Official - Middle Name:FISSEHA
Authorized Official - Last Name:AYEHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-998-3012
Mailing Address - Street 1:3451 KILBURN CIR APT 722
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1140
Mailing Address - Country:US
Mailing Address - Phone:804-263-8205
Mailing Address - Fax:
Practice Address - Street 1:3451 KILBURN CIR APT 722
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1140
Practice Address - Country:US
Practice Address - Phone:804-263-8205
Practice Address - Fax:804-998-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-24
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA623343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)