Provider Demographics
NPI:1669821294
Name:INNOVATIVE CARE TRANSPORTATION LLC
Entity type:Organization
Organization Name:INNOVATIVE CARE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABDIQADIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-470-1999
Mailing Address - Street 1:PO BOX 8594
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-0594
Mailing Address - Country:US
Mailing Address - Phone:612-470-1999
Mailing Address - Fax:
Practice Address - Street 1:105 BLAKE RD N APT 206
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8266
Practice Address - Country:US
Practice Address - Phone:612-470-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-04
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)