Provider Demographics
NPI:1669297214
Name:CHERRY CREEK TRANSPORT LLC
Entity type:Organization
Organization Name:CHERRY CREEK TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-937-5048
Mailing Address - Street 1:PO BOX 6102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-0102
Mailing Address - Country:US
Mailing Address - Phone:720-937-5048
Mailing Address - Fax:
Practice Address - Street 1:5322 ADAMS ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-2333
Practice Address - Country:US
Practice Address - Phone:720-937-5048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)