Provider Demographics
NPI:1982481974
Name:SHABACH TRANSPORT, INC.
Entity Type:Organization
Organization Name:SHABACH TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIMAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-670-3844
Mailing Address - Street 1:5525 MAPLEDALE PLZ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4527
Mailing Address - Country:US
Mailing Address - Phone:540-670-3844
Mailing Address - Fax:
Practice Address - Street 1:2222 COLTS NECK RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20191-2843
Practice Address - Country:US
Practice Address - Phone:703-429-1130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)