Provider Demographics
NPI:1972916138
Name:GOD'S WAY TRANSPORTATION LLC
Entity type:Organization
Organization Name:GOD'S WAY TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-340-2607
Mailing Address - Street 1:15800 FENKELL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-2309
Mailing Address - Country:US
Mailing Address - Phone:313-340-2607
Mailing Address - Fax:313-340-2604
Practice Address - Street 1:15800 FENKELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-2309
Practice Address - Country:US
Practice Address - Phone:313-340-2607
Practice Address - Fax:313-340-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTRANSPORTATION FOR WAYNE COUNTY