Provider Demographics
NPI:1700667680
Name:PEACE TRIP LLC
Entity Type:Organization
Organization Name:PEACE TRIP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:GAREDEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-373-4079
Mailing Address - Street 1:10617 WILEY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46231-1045
Mailing Address - Country:US
Mailing Address - Phone:317-373-4079
Mailing Address - Fax:
Practice Address - Street 1:10617 WILEY LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231-1045
Practice Address - Country:US
Practice Address - Phone:317-373-4079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)