Provider Demographics
NPI:1780810499
Name:TRIP VAN TRANSPORTAION
Entity type:Organization
Organization Name:TRIP VAN TRANSPORTAION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-271-6242
Mailing Address - Street 1:4837 E 88TH ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2011
Mailing Address - Country:US
Mailing Address - Phone:216-721-4262
Mailing Address - Fax:216-341-0048
Practice Address - Street 1:4837 E 88TH ST
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2011
Practice Address - Country:US
Practice Address - Phone:216-721-4262
Practice Address - Fax:216-341-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle