Provider Demographics
NPI:1316492077
Name:PROVIDENCE SAFEWAY TRANSPORTATION, LLC
Entity type:Organization
Organization Name:PROVIDENCE SAFEWAY TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ISABELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-787-1096
Mailing Address - Street 1:20 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43610-1522
Mailing Address - Country:US
Mailing Address - Phone:419-787-1096
Mailing Address - Fax:
Practice Address - Street 1:20 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43610-1522
Practice Address - Country:US
Practice Address - Phone:419-787-1096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)