Provider Demographics
NPI:1114720471
Name:SHADES TRANSPORT
Entity type:Organization
Organization Name:SHADES TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:TAUJUAN
Authorized Official - Last Name:PEARSALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-681-3497
Mailing Address - Street 1:640 PENNY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NC
Mailing Address - Zip Code:28398-7756
Mailing Address - Country:US
Mailing Address - Phone:336-681-3497
Mailing Address - Fax:
Practice Address - Street 1:640 PENNY BRANCH RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398-7756
Practice Address - Country:US
Practice Address - Phone:336-681-3497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)