Provider Demographics
NPI:1881762052
Name:OLSEN TRANSPORTATION, LLC
Entity type:Organization
Organization Name:OLSEN TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-458-4200
Mailing Address - Street 1:753 BOSTON POST RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2749
Mailing Address - Country:US
Mailing Address - Phone:203-458-5970
Mailing Address - Fax:203-458-5971
Practice Address - Street 1:753 BOSTON POST RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2749
Practice Address - Country:US
Practice Address - Phone:203-458-5970
Practice Address - Fax:203-458-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT=========Medicaid