Provider Demographics
NPI:1811145089
Name:LETZ GO TRANSPORTATION
Entity type:Organization
Organization Name:LETZ GO TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:JARRETT-BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-772-8407
Mailing Address - Street 1:1824 14TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-7807
Mailing Address - Country:US
Mailing Address - Phone:224-772-8407
Mailing Address - Fax:
Practice Address - Street 1:1824 14TH ST STE A
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-7807
Practice Address - Country:US
Practice Address - Phone:224-772-8407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-30
Last Update Date:2008-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL13061LY343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001OtherMEDICAID SYSTEM (MMIS)