Provider Demographics
NPI:1912775362
Name:SAFESIDE TRANSIT LLC.
Entity Type:Organization
Organization Name:SAFESIDE TRANSIT LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KHONESAVANH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVONGXAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-731-8724
Mailing Address - Street 1:3633 MORRIS ST # 3231
Mailing Address - Street 2:
Mailing Address - City:FRANKSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53126-9464
Mailing Address - Country:US
Mailing Address - Phone:414-731-8724
Mailing Address - Fax:
Practice Address - Street 1:3633 MORRIS ST # 3231
Practice Address - Street 2:
Practice Address - City:FRANKSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53126-9464
Practice Address - Country:US
Practice Address - Phone:414-731-8724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)