Provider Demographics
NPI:1063926541
Name:YAHWEH TRANSPORT SERVICES
Entity type:Organization
Organization Name:YAHWEH TRANSPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TURJALEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PANTOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-802-8926
Mailing Address - Street 1:3845 119TH AVE NW APT 27
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-6720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3845 119TH AVE NW APT 27
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-6720
Practice Address - Country:US
Practice Address - Phone:651-802-8926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========Medicaid