Provider Demographics
NPI:1881308294
Name:RELATIVE'S TRANSPORT LLC
Entity type:Organization
Organization Name:RELATIVE'S TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-460-3236
Mailing Address - Street 1:4451 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6003
Mailing Address - Country:US
Mailing Address - Phone:414-460-3236
Mailing Address - Fax:
Practice Address - Street 1:N19W24400 RIVERWOOD DR STE 350
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1182
Practice Address - Country:US
Practice Address - Phone:414-460-3236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)