Provider Demographics
NPI:1699503144
Name:GREEN RIVER TRANS LLC
Entity type:Organization
Organization Name:GREEN RIVER TRANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOKHTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:YOSEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-713-1723
Mailing Address - Street 1:1057 ROLAND LN APT 7
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-6041
Mailing Address - Country:US
Mailing Address - Phone:920-713-1723
Mailing Address - Fax:
Practice Address - Street 1:1057 ROLAND LN APT 7
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-6041
Practice Address - Country:US
Practice Address - Phone:920-713-1723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)