Provider Demographics
NPI:1811316011
Name:SOUTHERN BUS & MOBILITY, INC
Entity type:Organization
Organization Name:SOUTHERN BUS & MOBILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-526-4131
Mailing Address - Street 1:12950 KOCH LN
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-4220
Mailing Address - Country:US
Mailing Address - Phone:618-526-4131
Mailing Address - Fax:618-526-4585
Practice Address - Street 1:12950 KOCH LN
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-4220
Practice Address - Country:US
Practice Address - Phone:618-526-4131
Practice Address - Fax:618-526-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities