Provider Demographics
NPI:1124526991
Name:CROSS NON-EMERGENCY MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:CROSS NON-EMERGENCY MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FITSUM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABREHA
Authorized Official - Suffix:SR
Authorized Official - Credentials:OWNER
Authorized Official - Phone:480-277-1016
Mailing Address - Street 1:7027 S 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2266
Mailing Address - Country:US
Mailing Address - Phone:480-277-1016
Mailing Address - Fax:
Practice Address - Street 1:150 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2073
Practice Address - Country:US
Practice Address - Phone:480-277-1016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)