Provider Demographics
NPI:1720528912
Name:MARINE ONE, LLC
Entity Type:Organization
Organization Name:MARINE ONE, LLC
Other - Org Name:MARINE 1 TRANSIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BAILEY
Authorized Official - Last Name:HEMPSTEAD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:847-226-5458
Mailing Address - Street 1:610 NEWCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2783
Mailing Address - Country:US
Mailing Address - Phone:847-226-5458
Mailing Address - Fax:
Practice Address - Street 1:610 NEWCASTLE DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2783
Practice Address - Country:US
Practice Address - Phone:847-226-5458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle