Provider Demographics
NPI:1063871937
Name:SAFEWAY TRANSPORTATION LLC
Entity type:Organization
Organization Name:SAFEWAY TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSMAN
Authorized Official - Middle Name:ISSA
Authorized Official - Last Name:ELMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-399-7995
Mailing Address - Street 1:419 CEDAR AVE S # G385
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1032
Mailing Address - Country:US
Mailing Address - Phone:651-399-7995
Mailing Address - Fax:
Practice Address - Street 1:419 CEDAR AVE S # G385
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1032
Practice Address - Country:US
Practice Address - Phone:651-399-7995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN309EEL343900000X
MN938BJL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)