Provider Demographics
NPI:1548992233
Name:MASSAS TRANSPORTATION LLC
Entity type:Organization
Organization Name:MASSAS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MASSAS-CARABALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-359-0729
Mailing Address - Street 1:443 N PARKER DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-2443
Mailing Address - Country:US
Mailing Address - Phone:608-359-0729
Mailing Address - Fax:
Practice Address - Street 1:443 N PARKER DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-2443
Practice Address - Country:US
Practice Address - Phone:608-359-0729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)