Provider Demographics
NPI:1730720616
Name:C G TRANSPORT LLC
Entity type:Organization
Organization Name:C G TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ISREAL-PEACE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:919-514-0024
Mailing Address - Street 1:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:KITTRELL
Mailing Address - State:NC
Mailing Address - Zip Code:27544-0221
Mailing Address - Country:US
Mailing Address - Phone:919-703-8841
Mailing Address - Fax:919-435-1253
Practice Address - Street 1:135 AMBERGATE DR
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-7448
Practice Address - Country:US
Practice Address - Phone:919-703-8841
Practice Address - Fax:919-435-1253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40339586Medicaid