Provider Demographics
NPI:1205603545
Name:ROLLING WITH SHELLY LLC
Entity type:Organization
Organization Name:ROLLING WITH SHELLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:RUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-343-2403
Mailing Address - Street 1:5625 HALL RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-1952
Mailing Address - Country:US
Mailing Address - Phone:231-343-2403
Mailing Address - Fax:
Practice Address - Street 1:5625 HALL RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-1952
Practice Address - Country:US
Practice Address - Phone:231-343-2403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)