Provider Demographics
NPI:1902334576
Name:HOMERUN TRANSITION SERVICES LLC
Entity Type:Organization
Organization Name:HOMERUN TRANSITION SERVICES LLC
Other - Org Name:MYLIGHT TRANSPORTATION LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOU
Authorized Official - Middle Name:SU TAYLOR
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-263-2866
Mailing Address - Street 1:33 BATTLE CREEK PL
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4909
Mailing Address - Country:US
Mailing Address - Phone:651-263-2866
Mailing Address - Fax:
Practice Address - Street 1:33 BATTLE CREEK PL
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4909
Practice Address - Country:US
Practice Address - Phone:651-263-2866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management