Provider Demographics
NPI:1699906859
Name:ONE2GO LLC
Entity type:Organization
Organization Name:ONE2GO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRON
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-664-4729
Mailing Address - Street 1:29632 PARKWOOD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1565
Mailing Address - Country:US
Mailing Address - Phone:734-664-4729
Mailing Address - Fax:
Practice Address - Street 1:29632 PARKWOOD ST
Practice Address - Street 2:SUITE B
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1565
Practice Address - Country:US
Practice Address - Phone:734-664-4729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5945Medicare PIN