Provider Demographics
NPI:1720479447
Name:SAFE TRANSPORT INC.
Entity type:Organization
Organization Name:SAFE TRANSPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ERBENTRAUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-671-1758
Mailing Address - Street 1:3410 18TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1402
Mailing Address - Country:US
Mailing Address - Phone:262-671-1759
Mailing Address - Fax:262-347-3603
Practice Address - Street 1:3410 18TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1402
Practice Address - Country:US
Practice Address - Phone:262-671-1759
Practice Address - Fax:262-347-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI-560790343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)