Provider Demographics
NPI:1285157586
Name:DICKERSON FAMILY ENTERPRISE, LLC
Entity type:Organization
Organization Name:DICKERSON FAMILY ENTERPRISE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-893-4596
Mailing Address - Street 1:4350 BROWNSBORO RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1681
Mailing Address - Country:US
Mailing Address - Phone:502-893-4598
Mailing Address - Fax:502-893-4597
Practice Address - Street 1:4350 BROWNSBORO RD.
Practice Address - Street 2:STE. 110
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-893-4598
Practice Address - Fax:502-893-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)