Provider Demographics
NPI:1801321112
Name:CGC ENTERPRISES LLC
Entity type:Organization
Organization Name:CGC ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-264-6267
Mailing Address - Street 1:4101 W GREEN OAKS BLVD # 305-489
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-4462
Mailing Address - Country:US
Mailing Address - Phone:817-264-6267
Mailing Address - Fax:
Practice Address - Street 1:4101 W GREEN OAKS BLVD # 305-489
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-4462
Practice Address - Country:US
Practice Address - Phone:817-264-6267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802619502343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)