Provider Demographics
NPI:1720485352
Name:CANDY'S CAB LLC
Entity type:Organization
Organization Name:CANDY'S CAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-525-5560
Mailing Address - Street 1:594 HARTMAN LN
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-3173
Mailing Address - Country:US
Mailing Address - Phone:423-525-5560
Mailing Address - Fax:
Practice Address - Street 1:594 HARTMAN LN
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-3173
Practice Address - Country:US
Practice Address - Phone:423-525-5560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)