Provider Demographics
NPI:1881253540
Name:SEARS TRANSPORTAION, LLC
Entity type:Organization
Organization Name:SEARS TRANSPORTAION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:J
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-531-8857
Mailing Address - Street 1:PO BOX 99705
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-9705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17800 NORTHLAND PARK CT STE 104B2
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4304
Practice Address - Country:US
Practice Address - Phone:248-531-8857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI802142526Other802142526