Provider Demographics
NPI:1285279802
Name:TIVAN LLC
Entity type:Organization
Organization Name:TIVAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ODAFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-719-3090
Mailing Address - Street 1:9435 WATERSTONE BLVD, STE 140
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249
Mailing Address - Country:US
Mailing Address - Phone:513-719-3090
Mailing Address - Fax:513-454-6705
Practice Address - Street 1:5821 WILLIAMSBURG DR.
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053
Practice Address - Country:US
Practice Address - Phone:513-719-3090
Practice Address - Fax:513-454-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)