Provider Demographics
NPI:1427893809
Name:DEVOTED TRANSPORT LLC
Entity type:Organization
Organization Name:DEVOTED TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:KLECZKA-HARTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-604-8036
Mailing Address - Street 1:2920 WHIPPOORWILL RD
Mailing Address - Street 2:
Mailing Address - City:SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54313-8126
Mailing Address - Country:US
Mailing Address - Phone:920-604-8036
Mailing Address - Fax:
Practice Address - Street 1:2920 WHIPPOORWILL RD
Practice Address - Street 2:
Practice Address - City:SUAMICO
Practice Address - State:WI
Practice Address - Zip Code:54313-8126
Practice Address - Country:US
Practice Address - Phone:920-604-8036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)