Provider Demographics
NPI:1104398320
Name:CHERRY CAPITAL CAB LLC
Entity type:Organization
Organization Name:CHERRY CAPITAL CAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DORNBOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-492-6116
Mailing Address - Street 1:3002 GARFIELD RD N
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-5008
Mailing Address - Country:US
Mailing Address - Phone:231-492-6116
Mailing Address - Fax:
Practice Address - Street 1:3002 GARFIELD RD N
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-5008
Practice Address - Country:US
Practice Address - Phone:231-492-6116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi