Provider Demographics
NPI:1720302052
Name:FREESTATE TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:FREESTATE TRANSPORTATION, LLC
Other - Org Name:FREESTATE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAWUN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:703-926-3219
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:832 OREGON AVE
Practice Address - Street 2:SUITES K-L
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090
Practice Address - Country:US
Practice Address - Phone:410-609-2156
Practice Address - Fax:410-609-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport