Provider Demographics
NPI:1730893413
Name:TRUCKER'S HAVEN LLC
Entity type:Organization
Organization Name:TRUCKER'S HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GENIA
Authorized Official - Middle Name:LARESE
Authorized Official - Last Name:NEWKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-289-1767
Mailing Address - Street 1:897 GOLDEN PLUM LN
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-9724
Mailing Address - Country:US
Mailing Address - Phone:910-289-1767
Mailing Address - Fax:
Practice Address - Street 1:897 GOLDEN PLUM LN
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-9724
Practice Address - Country:US
Practice Address - Phone:910-289-1767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)