Provider Demographics
NPI:1336443845
Name:NORTH CENTRAL CARAVANS, L.L.C.
Entity type:Organization
Organization Name:NORTH CENTRAL CARAVANS, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZINDA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:715-623-7887
Mailing Address - Street 1:N914 CTY HWY D
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-9079
Mailing Address - Country:US
Mailing Address - Phone:715-623-2229
Mailing Address - Fax:715-623-4013
Practice Address - Street 1:719 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2042
Practice Address - Country:US
Practice Address - Phone:715-623-2229
Practice Address - Fax:715-623-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41487600Medicaid