Provider Demographics
NPI:1972368488
Name:CHERRY CREEK TC LLC
Entity type:Organization
Organization Name:CHERRY CREEK TC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:BEN MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-810-3911
Mailing Address - Street 1:7777 E YALE AVE APT C302
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-6074
Mailing Address - Country:US
Mailing Address - Phone:503-810-3911
Mailing Address - Fax:
Practice Address - Street 1:7777 E YALE AVE APT C302
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-6074
Practice Address - Country:US
Practice Address - Phone:503-810-3911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle