Provider Demographics
NPI:1811142607
Name:PROFILE TRANSPORTATION LLC
Entity type:Organization
Organization Name:PROFILE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMATHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-514-9499
Mailing Address - Street 1:3398 HARTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44112-3028
Mailing Address - Country:US
Mailing Address - Phone:216-514-9499
Mailing Address - Fax:216-514-9499
Practice Address - Street 1:3398 HARTWOOD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44112-3028
Practice Address - Country:US
Practice Address - Phone:216-514-9499
Practice Address - Fax:216-514-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18-761-5343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)