Provider Demographics
NPI:1801412945
Name:GENESIS GLOBAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:GENESIS GLOBAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-802-6667
Mailing Address - Street 1:4655 S LAKE PARK AVE APT 320
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-4534
Mailing Address - Country:US
Mailing Address - Phone:872-802-6667
Mailing Address - Fax:
Practice Address - Street 1:4655 S LAKE PARK AVE APT 320
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-4534
Practice Address - Country:US
Practice Address - Phone:872-802-6667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)