Provider Demographics
NPI:1316700164
Name:ELY TRANSPORT LLC
Entity type:Organization
Organization Name:ELY TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:BENELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-917-0415
Mailing Address - Street 1:1206 LONDONERRY LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1639
Mailing Address - Country:US
Mailing Address - Phone:513-917-0415
Mailing Address - Fax:
Practice Address - Street 1:1206 LONDONERRY LN
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1639
Practice Address - Country:US
Practice Address - Phone:513-917-0415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELY TRANSPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)