Provider Demographics
NPI:1669880589
Name:COUNTRY CROSSINGS LLC.
Entity type:Organization
Organization Name:COUNTRY CROSSINGS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:INITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-454-1279
Mailing Address - Street 1:PO BOX 1234
Mailing Address - Street 2:
Mailing Address - City:HUTCHINS
Mailing Address - State:TX
Mailing Address - Zip Code:75141-1234
Mailing Address - Country:US
Mailing Address - Phone:214-454-1279
Mailing Address - Fax:972-803-4720
Practice Address - Street 1:301 FIRST ST. STE 229
Practice Address - Street 2:
Practice Address - City:WILMER
Practice Address - State:TX
Practice Address - Zip Code:75172
Practice Address - Country:US
Practice Address - Phone:214-454-1279
Practice Address - Fax:972-803-4720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARNER EXPRESS LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09155266343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)