Provider Demographics
NPI:1538396312
Name:WATER'S EDGE TRANSPORTATION, LLC
Entity type:Organization
Organization Name:WATER'S EDGE TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MORSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-442-7022
Mailing Address - Street 1:380 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1738
Mailing Address - Country:US
Mailing Address - Phone:952-442-7022
Mailing Address - Fax:952-442-9022
Practice Address - Street 1:380 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1738
Practice Address - Country:US
Practice Address - Phone:952-442-7022
Practice Address - Fax:952-442-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN183739OtherUCARE
MN08N76WAOtherBLUE CROSS BLUE SHIELD
MN8100040OtherMEDICA
MN183740OtherUCARE
MNA520214100Medicaid
MN070305003OtherPRIME WEST