Provider Demographics
NPI:1902316870
Name:TRANSFIGURATION ENTERPRISES, LLC
Entity Type:Organization
Organization Name:TRANSFIGURATION ENTERPRISES, LLC
Other - Org Name:KJT TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHANNON
Authorized Official - Middle Name:R
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-828-9695
Mailing Address - Street 1:2515 AUTUMN RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-5006
Mailing Address - Country:US
Mailing Address - Phone:317-828-9695
Mailing Address - Fax:
Practice Address - Street 1:608 E 22ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1632
Practice Address - Country:US
Practice Address - Phone:317-828-9695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle