Provider Demographics
NPI:1215769450
Name:FORRIS IV CARE TRANSPORTATION LLC
Entity type:Organization
Organization Name:FORRIS IV CARE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FORRIS
Authorized Official - Middle Name:LACOSTE
Authorized Official - Last Name:FULFORD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:252-702-8651
Mailing Address - Street 1:4189 DALE DR
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-1217
Mailing Address - Country:US
Mailing Address - Phone:252-702-8651
Mailing Address - Fax:
Practice Address - Street 1:4189 DALE DR
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-1217
Practice Address - Country:US
Practice Address - Phone:252-702-8651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle