Provider Demographics
NPI:1497584023
Name:GENESIS MORTUARY TRANSPORT LLC
Entity type:Organization
Organization Name:GENESIS MORTUARY TRANSPORT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:K
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-243-3883
Mailing Address - Street 1:1285 W HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-6052
Mailing Address - Country:US
Mailing Address - Phone:903-243-3883
Mailing Address - Fax:
Practice Address - Street 1:1285 W HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-6052
Practice Address - Country:US
Practice Address - Phone:903-243-3883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS MORTUARY TRANSPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)