Provider Demographics
NPI:1992276620
Name:PROVIDENCE SENIOR TRANSPORTATION INC.
Entity type:Organization
Organization Name:PROVIDENCE SENIOR TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-361-1154
Mailing Address - Street 1:4684 MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1137
Mailing Address - Country:US
Mailing Address - Phone:855-850-5555
Mailing Address - Fax:330-899-9780
Practice Address - Street 1:4684 MASSILLON RD
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1137
Practice Address - Country:US
Practice Address - Phone:855-850-5555
Practice Address - Fax:330-899-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty