Provider Demographics
NPI:1982396362
Name:ECCENTRIC 28 TRANSPORTATION LLC
Entity Type:Organization
Organization Name:ECCENTRIC 28 TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAJUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-407-5900
Mailing Address - Street 1:6101 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1368
Mailing Address - Country:US
Mailing Address - Phone:773-407-5900
Mailing Address - Fax:
Practice Address - Street 1:6101 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1368
Practice Address - Country:US
Practice Address - Phone:773-407-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No347B00000XTransportation ServicesBus