Provider Demographics
NPI:1841856846
Name:LAKEFRONT TRANSPORTATION INC.
Entity type:Organization
Organization Name:LAKEFRONT TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:LERON
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-702-4415
Mailing Address - Street 1:5 SEVERANCE CIR STE 502
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1588
Mailing Address - Country:US
Mailing Address - Phone:216-702-4415
Mailing Address - Fax:216-472-8521
Practice Address - Street 1:5 SEVERANCE CIR STE 502
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1588
Practice Address - Country:US
Practice Address - Phone:216-702-4415
Practice Address - Fax:216-472-8521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0271829Medicaid