Provider Demographics
NPI:1548623895
Name:FAZARI TRANSPORTATION LIMITED
Entity type:Organization
Organization Name:FAZARI TRANSPORTATION LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WAGABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-338-9315
Mailing Address - Street 1:17705 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-2635
Mailing Address - Country:US
Mailing Address - Phone:216-338-9315
Mailing Address - Fax:216-481-8122
Practice Address - Street 1:17705 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-2635
Practice Address - Country:US
Practice Address - Phone:216-338-9315
Practice Address - Fax:216-481-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)